基于“PETTICOAT”技术的支架系统在B型主动脉夹层远端主动脉重构中的有效性分析——一项多中心“匹配”比较研究  

Evaluation of a stent system based on "PETTICOAT" technique in distal aortic remodeling for type B aortic dissection: a multi-center "Matching" comparative study

作　　者：胡诚凯 杨珏 王伟[3] 戴向晨[4] 陆信武[5] 戚悠飞[6] 张宏鹏[7] 张宇翀[1,2] 邱首继 曹根茂 王恩慈 林朋 莫凡迪 李仕毅 李哲昀 左梓昂 司逸 符伟国 王利新[1,2] Hu Chengkai;Yang Jue;Wang Wei;Dai Xiangchen;Lu Xinwu;Qi Youfei;Zhang Hongpeng;Zhang Yuchong;Qiu Shouji;Cao Genmao;Wang Enci;Lin Peng;Mo Fandi;Li Shiyi;Li Zheyun;Zuo Ziang;Si Yi;Fu Weiguo;Wang Lixin(Department of Vascular Surgery Vascular Surgery Institute of Fudan University,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Vascular Surgery,Zhongshan Hospital(Xiamen),Fudan University,Xiamen 361015,China;Department of Vascular Surgery,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Vascular Surgery,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Vascular Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Vascular Surgery,Hainan People Hospital,Haikou 570311,China;Department of Vascular Surgery,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]复旦大学附属中山医院血管外科复旦大学血管外科研究所,上海200032 [2]复旦大学附属中山医院(厦门)血管外科,厦门361015 [3]中南大学湘雅医院血管外科,长沙410008 [4]天津医科大学总医院血管外科,天津300052 [5]上海交通大学医学院附属第九人民医院血管外科,上海200011 [6]海南省人民医院血管外科,海口570311 [7]中国人民解放军总医院血管外科,北京100853

出　　处：《中华普通外科杂志》2024年第5期350-356,共7页Chinese Journal of General Surgery

基　　金：国家自然科学基金(82270415);上海市卫生健康委员会资助项目(20214Y0474)。

摘　　要：目的比较采用Fabulous支架系统修复和标准胸主动脉腔内修复(TEVAR)对B型主动脉夹层(TBAD)远端主动脉的重塑效果。方法收集2017年12月至2019年10月经Fabulous支架治疗的134例TBAD患者以及对应的多中心进行标准TEVAR治疗的159例TBAD患者的数据。通过倾向性匹配分析,对比两组患者在术后1年的预后和主动脉重塑效果。结果通过倾向性匹配分析,一共62例Fabulous治疗的患者和匹配的62例标准TEVAR治疗的患者纳入分析。两组患者在术前基线情况方面差异无统计学意义。在裸支架区域的主动脉重塑方面,Fabulous组患者在真腔最小直径[10.6(4.4,14.5)mm比4.7(0.9,10.7)mm,P=0.001]和假腔最大直径[-24.2(-30.5,-4.9)mm比0.7(-11.8,2.3)mm,P<0.001]的变化趋势均优于标准TEVAR组患者,且Fabulous组患者的假腔完全血栓化比例明显优于标准TEVAR组患者(62.9%比37.1%,P=0.042)。结论TBAD患者采用Fabulous支架系统有更好的远端主动脉重塑效果。Objective To compare the aortic remodeling of the Fabulous stent system and standard thoracic aortic endovascular repair(TEVAR)on distal aorta type B aortic dissection(TBAD).Methods The prospective data collected between Dec 2017 and Oct 2019 from 134 patients with type B aortic dissection(TBAD)who underwent treatment with the"Fabulous"stent system,and retrospective data from 159 TBAD patients receiving standard TEVAR from corresponding multicenter.By using propensity score matching analysis,we compared the prognosis and aortic remodeling outcomes in patients undergoing Fabulous and standard TEVAR treatments during a 1-year postoperative follow-up.Results In this study,62 patients in Fabulous group and 62 patients in standard TEVAR were included.There were no significant statistical differences in baseline characteristics between the two groups.In terms of aortic remodeling in bare stent region,Fabulous group had better change trends of diameter of true lumen[10.6(4.4,14.5)mm vs.4.7(0.9,10.7)mm,P=0.001]and false lumen[-24.2(-30.5,-4.9)mm vs.0.7(-11.8,2.3)mm,P<0.001]than those in the standard TEVAR group.The rate of complete false lumen thrombosis was also higher in the Fabulous group(62.9%vs.37.1%,P=0.042).Conclusion The Fabulous stent system,when compared to standard TEVAR surgery,demonstrates good aortic remodeling outcomes in the distal aorta.

关 键 词：主动脉 胸 动脉瘤 夹层 假腔血栓化 主动脉重塑 

分 类 号：R654.3[医药卫生—外科学]