长象鼻支架与急性A型主动脉夹层术后脊髓损伤风险的单中心回顾性队列研究  

Association of long frozen elephant trunk and incidence of spinal cord injury in patients with acute type A aortic dissection:A single center retrospective cohort study

作　　者：王超杰 张文倩 彭继海[5] 陈广田 郭海江 洪亮[1] 黄劲松[1] 范小平 WANG Chaojie;ZHANG Wenqian;PENG Jihai;CHEN Guangtian;GUO Haijiang;HONG Liang;HUANG Jinsong;FAN Xiaoping(Department of Cardiovascular Surgery,Guangdong Cardiovascular Institute,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou,510080,P.R.China;Department of Cardiovascular Surgery,Guangdong Provincial Hospital of Chinese Medicine,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou,510006,P.R.China;The Second School of Clinical Medicine,Southern Medical University,Guangzhou,510515,P.R.China;Department of Cardiac Pediatrics,Guangdong Cardiovascular Institute,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou,510080,P.R.China;Department of Rehabilitation,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou,510080,P.R.China)

机构地区：[1]广东省心血管病研究所心脏大血管外科广东省人民医院广东省医学科学院,广州510080 [2]广东省中医院心脏大血管外科广州中医药大学第二附属医院,广州510006 [3]南方医科大学第二临床医学院,广州510515 [4]广东省心血管病研究所心儿科广东省人民医院广东省医学科学院,广州510080 [5]广东省人民医院康复医学科广东省医学科学院,广州510080

出　　处：《中国胸心血管外科临床杂志》2022年第11期1450-1454,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨长象鼻支架是否增加急性A型主动脉夹层患者术后脊髓损伤的风险。方法纳入2018—2019年广东省人民医院心脏大血管外科收治的急性A型主动脉夹层患者172例,根据术中采用象鼻支架的长度将患者分为两组:支架长度100 mm的为短支架组,长度150 mm的为长支架组。短支架组124例,男108例(87.1%)、女16例(12.9%),年龄(51.8±7.9)岁;长支架组48例,男44例(91.7%)、女4例(8.3%),年龄(50.6±9.7)岁。总结并分析两组患者的临床资料及预后。结果对于术中支架远端锚定区,长支架组平均锚定于第(8.5±0.7)胸椎水平,短支架组平均锚定于第(6.8±0.6)胸椎水平(P=0.001)。术后两组共16例患者死亡[短支架组13例(10.5%)vs.长支架组3例(6.2%),P=0.561]。术后两组共7例脊髓损伤[短支架组6例(4.8%)vs.长支架组1例(2.2%),P=0.675]。再次开胸止血、内漏等并发症两组间差异亦无统计学意义。术后平均随访16.7(1~30)个月,长支架组随访期间2例死亡,短支架组随访期间5例死亡。出院后无新发脊髓截瘫或轻瘫,无远端再次手术干预。结论长象鼻支架不增加急性A型主动脉夹层患者术后脊髓损伤风险。Objective To evaluate whether long frozen elephant trunk(FET)increases the risk of spinal cord injury in patients with acute type A aortic dissection.Methods From 2018 to 2019,172 patients with acute type A aortic dissection were treated in Guangdong Provincial People’s Hospital.They were divided into two groups according to the length of FET:patients treated with stents of 100 mm in length were enrolled into a short FET group,and those with stents of 150 mm in length into a long FET group.There were 124 patients in the short FET group,including 108(87.1%)males and 16(12.9%)females with a mean age of 51.8±7.9 years.There were 48 patients in the long FET group,including 44(91.7%)males and 4(8.3%)females with a mean age of 50.6±9.7 years.The clinical data and prognosis of the patients were analyzed.Results The mean distal stent graft was at the level of T 8.5±0.7 in the long FET group,and at the level of T 6.8±0.6 in the short FET group(P=0.001).Sixteen patients died after operation in the two groups,including 13(10.5%)in the short FET group and 3(6.2%)in the long FET group(P=0.561).There were 7 patients of spinal cord injury in the two groups,including 6(4.8%)in the short FET group and 1(2.2%)in the long FET group(P=0.675).There was no statistical difference in other complications between the two groups.The follow-up time was 16.7(1-30)months.During the follow-up,2 patients died in the long FET group and 5 died in the short FET group.No new spinal cord injury or distal reintervention occurred during the follow-up.Conclusion Long FET does not increase the incidence of spinal cord injury in patients with acute type A aortic dissection.

关 键 词：主动脉夹层 象鼻支架 脊髓损伤 

分 类 号：R651.2[医药卫生—外科学] R654.3[医药卫生—临床医学]