Stanford B型主动脉夹层腔内修复术后逆行性A型主动脉夹层的影响因素分析  

Analysis of risk factors for retrograde type A aortic dissection after endovascular repair of Stanford type B aortic dissection

作　　者：邓利文 王子畅 左香燚 赵渝[1] 王学虎[1] DENG Liwen;WANG Zichang;ZUO Xiangyi;ZHAO Yu;WANG Xuehu(Department of Vascular Surgery,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,P.R.China)

机构地区：[1]重庆医科大学附属第一医院血管外科,重庆400016

出　　处：《中国普外基础与临床杂志》2025年第2期219-226,共8页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的分析Stanford B型主动脉夹层行胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)术后逆行性A型主动脉夹层(retrograde type A aortic dissection,RTAD)发生的相关危险因素,为防治RTAD提供参考。方法回顾性收集重庆医科大学附属第一医院2017年1月至2023年6月期间因Stanford B型主动脉夹层行TEVAR且符合纳入和排除标准的患者,采用多因素logistic回归分析影响RTAD发生的风险因素,检验水准α=0.05。结果经过严格的纳入和排除标准后最终纳入176例患者,有7例患者发生RTAD,发病率为3.98%。多因素logistic回归分析结果显示,俯视观主动脉中心线夹角τ角度越大[OR(95%CI)=1.195(1.032,1.384)]及主动脉弓弯曲程度(头臂干近端点至左锁骨下远端点的曲线距离)越小[OR(95%CI)=0.756(0.572,0.999)],TEVAR后发生RTAD的概率越大(P<0.05)。结论从本研究结果看,对Stanford B型主动脉夹层行TEVAR治疗患者,术前细致评估主动脉弓的形态学特征[特别是主动脉中心线夹角τ角和主动脉弓弯曲程度(头臂干近端点至左锁骨下远端点的曲线距离)]并据此调整手术方式对降低RTAD的发病率至关重要。Objective To analyze the risk factors relevant retrograde type A aortic dissection(RTAD)after thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection and provide a reference for its prevention and management.Methods A retrospective analysis was conducted on patients with Stanford type B aortic dissection who underwent TEVAR at the First Affiliated Hospital of Chongqing Medical University from January 2017 to June 2023.The patients met the inclusion and exclusion criteria were included in the study.The multivariate logistic regression was used to analyze the risk factors for RTAD,with a test level ofα=0.05.Results A total of 176 patients were included,among whom 7 developed RTAD,with an occurrence rate of 3.98%.The multivariate logistic regression analysis revealed that the largerτangle between the centerline of the aorta[OR(95%CI)=1.195(1.032,1.384)]and the degree of curvature of the aortic arch(the curve distance from the proximal brachiocephalic trunk to the distal left subclavian artery)[OR(95%CI)=0.756(0.572,0.999)],the higher probability of RTAD after TEVAR(P<0.05).Conclusions From the results of this study,it can be seen that for patients with Stanford B-type aortic dissection underwent TEVAR treatment,careful preoperative evaluation of morphological characteristics of the aortic arch(particularly theτangle of the aorta centerline and the degree of curvature of the aortic arch(the curve distance from the proximal brachiocephalic trunk to the distal left subclavian artery)is crucial for reducing the occurrence of RTAD after TEVAR in patients with Stanford type B aortic dissection.

关 键 词：Stanford B型主动脉夹层 胸主动脉腔内修复术 逆行性A型主动脉夹层 风险因素 

分 类 号：R654.3[医药卫生—外科学]