分支型主动脉覆膜支架与烟囱支架技术在Stanford B型主动脉夹层患者中的应用价值  

Application value of branch type aortic covered stent and chimney stent technology in patients with Stanford type B aortic dissection

作　　者：崔元生 李龙彪 杨智洪 尚祥 刘建雄 许舒国 Cui Yuansheng;Li Longbiao;Yang Zhihong;Shang Xiang;Liu Jianxiong;Xu Shuguo(Department of Interventional Vascular Surgery,Ningde City Hospital Affiliated to Ningde Normal University,Ningde 352100,Fujian,China)

机构地区：[1]宁德师范学院附属宁德市医院介入血管外科,福建宁德352100

出　　处：《血管与腔内血管外科杂志》2024年第3期332-337,共6页Journal of Vascular and Endovascular Surgery

摘　　要：目的 探讨分支型主动脉覆膜支架与烟囱支架技术在Stanford B型主动脉夹层(TBAD)治疗中的应用价值。方法 收集2018年3月至2021年3月宁德师范学院附属宁德市医院收治的60例TBAD患者的临床资料,并按照胸主动脉腔内修复术(TEVAR)后重建左锁骨下动脉血运方式的不同将患者分为观察组(采用分支型主动脉覆膜支架技术)与对照组(采用烟囱支架技术),每组30例。比较两组患者的手术成功率、手术时间、术中出血量,术后2周、3个月、6个月及1年支架通畅率情况,术前、术后2周、术后3个月、术后6个月及术后1年主动脉重塑情况;术后随访期间并发症发生情况,以及出院前、出院后6个月生存质量。结果 两组患者的手术成功率均为100%。观察组患者手术时间短于对照组,术中Ⅰ型内漏的发生率低于对照组患者(P﹤0.05)。两组患者术后2周、3个月、6个月及1年后支架通畅率,以及术前夹层真腔直径、夹层假腔直径比较,差异均无统计学意义(P﹥0.05)。随着术后时间的延长,两组患者的夹层真腔直径逐渐增加,术后夹层假腔直径逐渐降低;观察组患者术后夹层真腔直径高于对照组患者,术后夹层假腔直径低于对照组患者,差异均有统计学意义(P﹤0.05)。观察组患者术后1年假腔血栓化的比例、术后并发症总发生率均低于对照组患者,差异均有统计学意义(P﹤0.05)。出院后6个月,观察组患者健康调查简表中各维度的评分均明显高于对照组患者,差异均有统计学意义(P﹤0.01)。结论 在采用TEVAR治疗TBAD的过程中,分支型主动脉覆膜支架技术与烟囱支架技术均显示出较好的疗效,但前者的治疗安全性与有效性更好,患者术后生存质量更高。Objective To investigate the application value of branch type aortic covered stent and chimney stent technology in the treatment of Stanford type B aortic dissection(TBAD).Method Clinical data of 60 patients with TBAD who were treated by thoracic endovascular aortic repair(TEVAR)from March 2018 to March 2021 in Ningde City Hospital Affiliated to Ningde Normal University were collected.According to the different ways of reconstructing the blood flow of the left subclavian artery after TEVAR,they were divided into the observation group(n=30,treated with branch type aortic covered stent technology)and the control group(n=30,treated with chimney stent technology).The surgical success rate,surgical time,intraoperative blood loss;patency rate of stent at 2 weeks,3 months,6 months,1 year after surgery;aortic remodeling before surgery,2 weeks after surgery,3 months after surgery,6 months after surgery,and 1 year after surgery;incidence of complications during postoperative follow-up,and quality of life before discharge and 6 months after discharge were compared between the two groups.Result The success rate of surgery for both groups of patients were 100%.The observation group had shorter surgical time than the control group,and the incidence of type I internal leakage during surgery was lower than that of the control group(P<0.05).There were no statistically significant differences in the stent patency rate at 2 weeks,3 months,6 months,and 1 year after surgery,as well as the true and false diameter of the dissection before surgery between the two groups of patients(P>0.05).With the prolongation of postoperative time,the true lumen diameter of the dissection in both groups of patients gradually increased,while the false lumen diameter of the dissection gradually decreased after surgery;the true lumen diameter of the dissection in the patients in the observation group was higher than that in the patients in the control group,and the false lumen diameter of the dissection in the patients in the observation group was lower

关 键 词：分支型主动脉覆膜支架 烟囱支架技术 Stanford B型主动脉夹层 应用价值 

分 类 号：R543[医药卫生—心血管疾病]