不同主动脉弓上重建方式治疗近端不良锚定区Stanford B型主动脉夹层的疗效分析  

Efficacy analysis of different supra-aortic reconstruction methods for Stanford type B aortic dissection with proximal poor anchoring area

作　　者：肖玉林 霍静 沈祥怡 吴忠隐 吴峥 王琦 张弘[1] Xiao Yulin;Huo Jing;Shen Xiangyi;Wu Zhongyin;Wu Zheng;Wang Qi;Zhang Hong(Department of Vascular Surgery,the Affiliated Hospital of Chengde Medical College,Hebei Key Laboratory of Panvascular Diseases,Chengde 067000,Hebei,China;Department of General Medical,the Affiliated Hospital of Chengde Medical College,Chengde 067000,Hebei,China)

机构地区：[1]承德医学院附属医院血管外科,河北省泛血管疾病重点实验室,河北承德067000 [2]承德医学院附属医院全科医疗科,河北承德067000

出　　处：《血管与腔内血管外科杂志》2024年第4期434-441,共8页Journal of Vascular and Endovascular Surgery

基　　金：河北省民生科技专项(20377792D)。

摘　　要：目的探讨不同主动脉弓上重建方式治疗近端不良锚定区Stanford B型主动脉夹层患者的疗效。方法收集2015年1月至2021年12月于承德医学院附属医院行主动脉弓上动脉重建技术治疗的90例近端不良锚定区Stanford B型主动脉夹层患者的临床资料,按照不同的弓上重建方式分将其为烟囱技术组(n=19)、开窗技术组(n=47)和Castor单分支支架技术组(n=24)。所有患者术后至少随访24个月,比较三组患者并发症发生情况、生存情况以及主动脉重塑情况。结果三组患者手术成功率均为100%,三组患者院内不良事件总发生率比较,差异有统计学意义(P﹤0.05);烟囱组患者内漏发生率均高于开窗组、Castor组患者,差异均有统计学意义(P﹤0.05)。三组患者院外并发症发生率及病死率比较,差异均无统计学意义(P﹥0.05)。烟囱组、开窗组、Castor组患者2年累积生存率分别为94.4%、93.6%、95.8%。术后6个月,开窗组与Castor组患者胸主动脉段假腔血栓情况优于烟囱组患者,差异均有统计学意义(P﹤0.05)。术后6个月,三组患者支架植入S1平面的真腔与假腔直径变化率比较,差异均有统计学意义(P﹤0.05),Castor组患者真腔增大率与假腔减小率均高于烟囱组、开窗组患者(P﹤0.05);S2平面,Castor组患者的假腔减小率高于开窗组、烟囱组患者(P﹤0.05);S3与S4平面,三组患者真假腔直径变化率比较,差异均无统计学意义(P﹥0.05);S4平面,三组患者在真腔与假腔直径甚至呈现负重塑变化。三组患者在不同平面全主动脉直径随时间变化不明显,S1~S3平面,三组患者的真腔直径随时间呈增大趋势,假腔直径随时间呈减小趋势,最后趋于稳定;S4平面,三组患者真假腔直径随时间变化不明显,甚至呈现负重塑变化。结论烟囱、开窗、Castor技术治疗近端不良锚定区Stanford B型主动脉夹层均安全可行,应用烟囱技术的患者在院内有着较高的Ⅰ型内漏发Objective To investigate the effect of different supra-aortic arch reconstruction methods in the treatment of Stanford type B aortic dissection with proximal poor anchoring zone.Method Clinical data of 90 Stanford type B aortic dissection patients with poor proximal anchoring area treated by superior aortic arch reconstruction technique in the Affiliated Hospital of Chengde Medical College from January 2015 to December 2021 were collected.They were divided into chimney group(n=19),window group(n=47)and Castor single branch support group(n=24)according to different methods of arch reconstruction.All patients were followed up for at least 24 months after surgery to compare the incidence of complications,survival and aortic remodeling among the three groups.Result The surgical success rate of the three groups was 100%,and the total incidence of in-hospital adverse events of the three groups had statistical significance(P<0.05),and the incidence of internal leakage in the chimney group was higher than that in the open window group and Castor group,with statistical significance(P<0.05).There was no significant difference in the incidence of out-of-hospital complications and mortality among the three groups(P>0.05).The 2-year cumulative survival rates were 94.4%in the chimney group,93.6%in the window group and 95.8%in the Castor group,respectively.At 6 months after surgery,the situation of thoracic aortic pseudothrombus in the fenestrated group and Castor group was better than that in the chimney group,with statistical significance(P<0.05).Six months after surgery,the change rates of true cavity diameter and false cavity diameter in S1 plane of the three groups were statistically significant(P<0.05),and the true cavity enlargement rate and false cavity reduction rate in Castor group were higher than those in chimney group and open window group(P<0.05).In the S2 plane,the reduction rate of false cavity in Castor group was higher than that in open window group and chimney group(P<0.05).There was no significant difference

关 键 词：Stanford B型主动脉夹层 弓上重建 并发症 主动脉重塑 生存分析 

分 类 号：R543[医药卫生—心血管疾病]