胸腹主动脉夹层瘤和退行性胸腹主动脉瘤腔内治疗结果对比研究  

Comparative outcomes of endovascular aortic repair for post-dissection and degenerative thoracoabdominal aortic aneurysms

作　　者：瞿进 曾照祥 何孟伟 霍威学 张恒 陆烨 田文 冯睿 QU Jin;ZENG Zhaoxiang;HE Mengwei;HUO Weixue;ZHANG Heng;LU Ye;TIAN Wen;FENG Rui(Department of Vascular Surgery,Shanghai General Hospital,Shanghai 201600,China)

机构地区：[1]上海市第一人民医院血管外科,上海201600

出　　处：《山东大学学报（医学版）》2024年第11期14-21,共8页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(82270505);上海市申康市级医院新兴前沿技术联合攻关项目(SHDC12022107)。

摘　　要：目的 对比胸腹主动脉夹层瘤和退行性胸腹主动脉瘤患者的腔内治疗效果,评价腔内技术应用于胸腹主动脉夹层瘤和退行性胸腹主动脉瘤的可行性和安全性。方法 回顾性收集2021年12月至2024年2月于上海市第一人民医院接受腔内治疗的34例胸腹主动脉夹层瘤患者和25例退行性胸腹主动脉瘤患者的相关临床资料(包括基线资料、手术资料、围手术期指标及随访期指标)。结果 夹层动脉瘤组和退行性动脉瘤组的腔内技术成功率均为100%。夹层动脉瘤组围手术期死亡率为0,发生脑梗1例(2.94%),Ⅲ型内漏1例(2.94%),移植物植入后综合征3例(8.82%);退行性动脉瘤组围手术期发生死亡2例(8.00%),急性肾损伤1例(4.00%)。随访期间夹层动脉瘤组发生死亡1例(2.94%),动脉瘤进展2例(5.88%),Ⅲ型内漏1例(2.94%),分支血管再狭窄或闭塞3例(8.82%),再干预5例(14.71%);退行性动脉瘤组发生死亡0例,动脉瘤进展1例(4.00%),Ⅰ型内漏1例(4.00%),Ⅲ型内漏1例(4.00%),分支血管再狭窄或闭塞2例(8.00%),再干预3例(12.00%)。两组患者的围手术期和随访期结果差异均无统计学意义(P>0.05)。结论 胸腹主动脉夹层瘤和退行性胸腹主动脉瘤腔内治疗具有相近的技术成功率以及早期和中期结果。但本研究结果仍需更多的病例及更长的随访时间进行验证,以进一步探究胸腹主动脉瘤腔内治疗的安全性和有效性,尤其是中期和远期疗效。Objective To evaluate the feasibility and safety of endovascular aortic repair for post-dissection and degenerative thoracoabdominal aortic aneurysms by comparing their therapeutic effects.Methods We retrospectively collected the clinical data(including baseline data,surgical data,perioperative indicators,and follow-up indicators)from 34 patients with post-dissection thoracoabdominal aortic aneurysms and 25 patients with degenerative thoracoabdominal aortic aneurysms who underwent endovascular aortic repair in Shanghai General Hospital from December 2021 to February 2024.Results The success rate of endovascular aortic repair in both the post-dissection thoracoabdominal aortic aneurysm group and the degenerative thoracoabdominal aortic aneurysm group was 100%.The perioperative mortality rate in the post-dissection aneurysm group was 0,with cerebral infarction in 1 case(2.94%),type III leakage in 1 case(2.94%),and post-graft implantation syndrome in 3 cases(8.82%);while in the degenerative aneurysm group,2 patients(8.00%)died and 1 case(4.00%)experienced acute kidney injury.During the follow-up period,1 case(2.94%)died,2 cases(5.88%)had aneurysm progressions,1 case(2.94%)had type III internal leakage,3 cases(8.82%)had branch vessel restenosis or occlusion,and 5 cases(14.71%)were re-intervened in the post-dissection aneurysm group;while in the degenerative aneurysm group,0 cases died,1 case(4.00%)had aneurysm progression,1 case(4.00%)had typeⅠendoleak,1 case(4.00%)had type III endoleak,2 cases(8.00%)had branch vessel restenosis or occlusion,and 3 cases(12.00%)experienced re-intervention.There was no significant difference in perioperative and follow-up outcomes between the two groups(P>0.05).Conclusion Endovascular aortic repair for post-dissection and degenerative thoracoabdominal aortic aneurysms has similar technical success rates and early and mid-term outcomes.However,the results of this study need to be verified with more cases and longer follow-up time to further investigate the safety and efficacy of endov

关 键 词：胸腹主动脉夹层瘤 退行性胸腹主动脉瘤 腔内治疗 中期结果 再干预 

分 类 号：R654.3[医药卫生—外科学]