介入治疗复杂Stanford B型主动脉夹层  

Interventional treatments of complex Stanford type B aortic dissection

作　　者：胡西塔尔·木汗曼提别克 贾钢毅 哈力木拉提·木尔提扎[1] 哈尔满·阿吉汗[1] 罗军[1] HUXITAER Muhanmantibieke;JIA Gangyi;HALIMULATI Muertiza;HAERMAN Ajihan;LUO Jun(Department of Vascular and Thyroid Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院血管甲状腺外科,新疆乌鲁木齐830054

出　　处：《中国介入影像与治疗学》2025年第1期6-10,共5页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的 观察介入治疗累及弓上分支血管的复杂Stanford B型主动脉夹层(TBAD)的有效性及安全性。方法将114例接受胸主动脉腔内修复术(TEVAR)的TBAD分为A组[封堵左锁骨下动脉(LSA)、覆盖LSA开口大于75%,n=49]、B组(重建并恢复LSA血供,n=54)、C组(重建并恢复LSA+左颈总动脉血供,n=7)及D组(重建并恢复弓上3分支血供,n=4),将B组分为烟囱亚组(n=18)、体外开窗亚组(n=22)、原位开窗亚组(n=7)及Castor支架亚组(n=7)。记录治疗成功率,比较组间及B组各亚组间介入治疗用时及围术期并发症。结果 B组治疗成功率98.15%(53/54),其余3组成功率均为100%。A组介入治疗用时少于B组,A、B组用时少于C、D组(校正P均<0.05)。4组间围术期并发症发生率(分别为36.73%、12.96%、42.86%及50.00%)总体差异有统计学意义(P=0.009),而两两比较均无统计学意义(校正P均>0.05)。B组内烟囱亚组介入治疗用时少于体外开窗亚组(校正P<0.05);各亚组间围术期并发症发生率差异均无统计学意义(P均>0.05)。结论 介入治疗累及弓上分支血管的复杂TBAD有效且安全。Objective To observe the efficacy and safety of interventional treatments of complex Stanford type B aortic dissection(TBAD)involving supra-aortic branches.Methods A total of 114 patients with TBAD who underwent thoracic endovascular aortic repair(TEVAR)were retrospectively enrolled and divided into 4 groups,i.e.group A(occlusion of the left subclavian artery[LSA],with over 75%coverage of the LSA orifice,n=49),group B(reconstruction and revascularization of LSA,n=54),group C(reconstruction and revascularization of both LSA and left common carotid artery,n=7)and group D(reconstruction and revascularization of all three supra-aortic branches,n=4).Patients in group B were further divided into chimney stent subgroup(n=18),in vitro fenestration subgroup(n=22),in situ fenestration subgroup(n=7)and Castor stent subgroup(n=7).The treatment success rates were recorded,and the duration of procedures and perioperative complications were compared among groups and subgroups within group B.Results The treatment success rate of group B was 98.15%(53/54),while the treatment success rates in the other three groups were all 100%.The procedure duration was shorter in group A than that in group B,while both shorter than that in group C and D(all adjusted P<0.05).There were significant differences of perioperative complications rates(36.73%,12.96%,42.86%and 50.00%,respectively)among 4 groups(P=0.009),but no statistical significance was found in pairwise comparisons(all adjusted P>0.05).Within group B,the intervention treatment time of chimney stent subgroup was shorter than that of in vitro fenestration subgroup(adjusted P<0.05),and no significant difference of incidence of perioperative complications was observed among 4 subgroups(all P>0.05).Conclusion Interventional treatments of complex TBAD involved supra-aortic branches were safe and effective.

关 键 词：主动脉夹层 血管内操作 血管造影术 数字减影 

分 类 号：R543.1[医药卫生—心血管疾病] R815[医药卫生—内科学]