54例胸主动脉腔内修复术治疗B型主动脉壁内血肿10年生存分析  

Thoracic endovascular aortic repair of type B aortic intramural haematoma in 54 cases:a ten-year survival analysis

作　　者：马金辉 朱亚东 陈江波 崔明哲 梁凯 翟水亭 MA Jinhui;ZHU Yadong;CHEN Jiangbo;CUI Mingzhe;LIANG Kai;ZHAI Shuiting(Department of Vascular Surgery,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,People's Hospital of Henan Provincial University,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院,郑州大学人民医院,河南大学人民医院血管外科,450003

出　　处：《心肺血管病杂志》2023年第1期53-57,62,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：河南省基础与前沿技术研究计划项目(142300410275)。

摘　　要：目的:评估胸主动脉腔内修复术(TEVAR)方式治疗B型主动脉壁内血肿(IMH)的临床效果和风险。方法:选取河南省人民医院血管外科2011年12月至2021年12月期间收治的54例B型IMH行TEVAR患者作为研究对象,对患者的临床资料进行回顾性分析。结果:TEVAR治疗54例B型IMH,技术成功率100%。其中单纯行TEVAR36例,左锁骨下动脉(LSA)开口部分覆盖6例,LSA开口全部覆盖2例,LSA重建10例。围术期1例逆撕A型主动脉夹层行外科手术,1例出现脑梗死给予保守治疗,1例因出现新发破口再次干预行TEVAR,所有患者全部存活出院。随访13~112个月,平均随访(63±10.5)个月,失访3例,有效随访率94%。随访患者共6例死亡,2例患者再干预手术,K-M生存曲线显示10年总存活率79.8%。结论:B型IMH行TEVAR技术成功率高,创伤小,恢复快,远期预后好。然而,围术期有逆撕A型主动脉夹层及脑梗死等风险。对于血肿累及LSA开口导致近端锚定区不足的患者,尽可能选择个体化方案重建LSA,部分覆盖或者完全覆盖LSA开口一定要慎重。Objective:To evaluate the clinical efficacy and risk of thoracic endovascular aortic repair(TEVAR)for the treatment of type B aortic intramural haematoma(IMH).Methods:From December 2011 to December 2021,54 patients with type B IHM underwent TEVAR in our hospital were selected as subjects,the clinical data of the patients were retrospectively analyzed.Results:A total of 54 patients with type B IHM were treated by TEVAE,the technical success rate was 100%.Among them,36 patients underwent TEVAR only,the orifice of left subclavian artery(LSA)was partially covered in 6 patients,the orifice of LSA was completely covered in 6 patients,the LSA was reconstructed in 10 patients.During perioperative period,one patient required emergency surgery because of retrograde type A aortic dissection,one patient developed cerebral infarction and was treated conservatively,one patient underwent reintervention by TEVAR again because of new entry tears.All patients survived and were discharged.The average follow-up time was(63±10.5)months(from 13 to 112 months),3 patients were lost to follow-up,and the effective follow-up rate was 94%.Six patients died and two patients underwent reintervention by surgery during follow-up.Kaplan-Meier analysis showed patient survival as 79.8%at ten-year.Conclusions:TEVAR for type B aortic intramural hematoma has the advantage of high success rate,small trauma,rapid recovery and good long-term prognosis.However,there are risks of retrograde type A aortic dissection and cerebral infarction during perioperative period.For patients with insufficient proximal anchorage zone due to hematoma involving LSA orifice,individualized treatment should be selected to rebuild LSA as much as possible,and we must be very careful to cover the orifice of LSA partially or completely.

关 键 词：主动脉壁内血肿 胸主动脉腔内修复术 主动脉夹层 左锁骨下动脉 

分 类 号：R54[医药卫生—心血管疾病]