Stanford B型主动脉夹层腔内修复术的手术时机对预后的影响  

Effect of surgical timing on prognosis of Stanford type B aortic dissection endovascular repair

作　　者：葛静 刘建平[1] 邹坪益 马蓉[1] 唐小娇 陈权[1] 龚晟[1] 贺一伟 张强[1] 郑永 张永恒[1] GE Jing;LIU Jianping;ZHOU Pingyi;MA Rong;TANG Xiaojiao;Chen Quan;GONG Sheng;HE Yiwei;ZHANG Qiang;ZHENG Yong;ZHANG Yongyong(Department of Cardiovascular Surgery,Suining Central Hospital,Suining 629000,China)

机构地区：[1]遂宁市中心医院心血管外科,629000 [2]遂宁市中医院心血管内科,629000

出　　处：《心肺血管病杂志》2023年第10期1042-1048,共7页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨Stanford B型主动脉夹层(type B aortic dissection,TBAD)胸主动脉腔内修复(thoracic endovascular aortic repair,TEVAR)术的手术时机对预后的影响。方法:回顾性分析2015年6月到2020年6月,在单中心行TEVAR治疗的TBAD患者的临床资料,收集患者一般基线资料:住院号、姓名、性别、年龄、吸烟史、饮酒史、既往疾病史(高血压、冠心病、糖尿病、高脂血症)。围术期及随访期死亡,围术期及随访期并发症:内漏、覆膜支架移位、覆膜支架远端新发夹层、逆撕A型夹层、脑卒中、脊髓缺血、急性肾损伤等。结果:共纳入217例TBAD患者,其中急性期(A组)患者141例,平均年龄(60.1±12.8)岁;非急性期(B组)患者76例,平均年龄(63.5±11.4)岁。男性患者160例,女性患者57例。两组患者在术后30d死亡率(2.8%vs.2.6%),主动脉相关性死亡率(2.8%vs.2.6%),主要并发症发生率(14.9%vs.14.5%);随访期死亡率(5.8%vs.10.8%),主动脉相关性死亡率(3.6%vs.5.4%),主要并发症发生率(8.8%vs.6.8%),组间差异均无统计学意义(P>0.05)。Renyi检验比较两组患者的5年生存率,差异无统计学意义(Q=1.544,P=0.245)。结论:TBAD急性期与非急性期术后并发症发生率、主动脉相关性死亡率及生存率差异无统计学意义,可能提示TBAD急性期手术不会带来更高的并发症及死亡风险。Objective:To investigate the effect of timing on the prognosis of Thoracic endovascular aortic repair(TEVAR)in Stanford Type B aortic dissection(TBAD).Methods:Clinical data of patients with TBAD treated with TEVAR in a single center from June 2015 to June 2020 were retrospectively analyzed.General baseline data of the patients were collected,including hospitalization number,name,gender,age,smoking history,drinking history,and past disease history(hypertension,coronary heart disease,diabetes,and hyperlipidemia).Perioperative and follow-up period death and perioperative and follow-up period complications,such as internal leakage,stent displacement,new hairpin at the distal end of the stent,type A dissection,stroke,spinal cord ischemia,and acute kidney injury,were noted.Results:A total of 217 patients with TBAD were enrolled,including 141 patients in acute stage(group A),aged(60.1±12.8)years.Seventy-six patients in the non-acute stage(group B)were aged(63.5±11.4)years.There were 160 male patients and 57 female patients.Postoperative 30-day mortality(2.8%vs.2.6%),aorta-related mortality(2.8%vs.2.6%),and incidence of major complications(14.9%vs.14.5%)were determined.Mortality during follow-up(5.8%vs.10.8%),aorta-related mortality(3.6%vs.5.4%),and incidence of major complications(8.8%vs.6.8%)were compared.We found no significant differences among groups(P>0.05).Renyi test showed no significant difference in the 5-year survival rate between the two groups(Q=1.544,P=0.245).Conclusions:There was no difference in the incidence of postoperative complications,aortic related mortality and survival between the acute and non-acute stages of TBAD,suggesting that the acute stage of TBAD surgery does not bring higher risk of complications and death.

关 键 词：主动脉夹层 胸主动脉腔内修复术 并发症 死亡率 生存率 手术时机 

分 类 号：R54[医药卫生—心血管疾病]