覆膜支架腔内隔绝术对高海拔地区B型主动脉夹层疗效及预后因素  

Efficacy of endovascular graft exclusion with covered stent in treatment of type B aortic dissection at high altitude and related prognostic factors

作　　者：赵名贤 李国杰 ZHAO Mingxian;LI Guojie(Department of Vascular Surgery,Qinghai Provincial Cardiovascular and Cerebrovascular Disease Specialized Hospital,Xining 810000,China)

机构地区：[1]青海省心脑血管病专科医院血管外科,青海西宁810000

出　　处：《青岛大学学报(医学版)》2025年第1期109-114,共6页Journal of Qingdao University(Medical Sciences)

基　　金：青海省卫生健康系统指导性计划课题(2022-wjzdx-47)。

摘　　要：目的探讨覆膜支架腔内隔绝术(EVGE)治疗高海拔地区B型主动脉夹层(TBAD)的效果及其预后影响因素。方法2015年1月—2020年12月,青海省心脑血管病专科医院采用EVGE治疗久居高海拔地区(海拔3000 m以上)的TBAD病人294例,对其临床及影像学资料进行回顾性分析。对病人术后的临床疗效进行长期随访,记录术后0.5、1.0和3.0年的疗效及并发症,并对预后的影响因素进行分析。结果294例TBAD病人行EVGE手术均取得成功,手术成功率为100.0%,病人术后0.5、1.0和3.0年的生存率分别为100.0%、97.6%和94.9%。术后0.5年随访出现内漏9例(3.1%),肾功能不全6例(2.0%)。术后1.0年随访出现内漏13例(4.4%),无症状脑卒中8例(2.7%),突发胸腹部疼痛、呕血死亡7例(2.4%)。与术前比较,术后1.0年主动脉峡部段、降主动脉中端、降主动脉远端和腹腔干段等部位真腔的短径均较术前显著增加,而假腔短径较术前明显缩短(t=2.301~12.462,P<0.05)。术后3.0年随访出现内漏24例(8.2%),逆行性A型夹层16例(5.4%),术后假腔破裂死亡15例(5.1%),支架内附壁血栓形成9例(3.1%),截瘫7例(2.4%),夹层远端再破裂或再手术6例(2.0%)。预后不良组年龄≥60岁、二级及以上高血压史及低氧血症史的构成比均显著高于预后良好组(χ^(2)=5.560~27.997,P<0.05)。多因素Cox回归分析显示,年龄≥60岁(HR=2.666,95%CI=1.313~3.726)、二级及以上高血压史(HR=3.380,95%CI=1.540~7.418)和低氧血症史(HR=4.646,95%CI=1.806~11.950)等变量均是高海拔地区TBAD病人EVGE术后预后不良的影响因素(P<0.05)。结论EVGE治疗高海拔地区TBAD病人的临床疗效较好,胸主动脉段重塑满意,病人短中长期预后较佳。年龄≥60岁、二级及以上高血压史和低氧血症史是影响病人预后的危险因素。Objective To investigate the efficacy of endovascular graft exclusion(EVGE)with covered stent in the treatment of type B aortic dissection(TBAD)at high altitude and the influencing factors for prognosis.Methods A retrospective analysis was performed for the clinical and imaging data of 294 patients with TBAD who lived at high altitude(with an altitude of>3000 m)for a long time and underwent EVGE in Qinghai Provincial Cardiovascular and Cerebrovascular Disease Specialized Hospital from January 2015 to December 2020.Long-term follow-up was performed to observe the clinical outcome of patients after surgery,and clinical outcomes and complications were recorded at 0.5,1.0,and 3.0 years after surgery.The influencing factors for prognosis were also analyzed.Results All 294 patients underwent a successful EVGE surgery,with a success rate of 100.0%,and their survival rates at 0.5,1.0,and 3.0 years after surgery were 100.0%,97.6%,and 94.9%,respectively.Follow-up at 0.5 years after surgery showed that 9 patients(3.1%)had internal leakage and 6(2.0%)had renal insufficiency,and follow-up at 1.0 year after surgery showed internal leakage in 13 patients(4.4%),asymptomatic stroke in 8 patients(2.7%),and sudden chest and abdominal pain,hematemesis,and death in 7 patients(2.4%).At 1.0 year after surgery,there was a significant increase in the short diameter of the true lumen in the isthmus segment,the middle segment of the descending aorta,the distal segment of the descending aorta,and the celiac trunk of the abdominal aorta,while there was a significant reduction in the short diameter of the false lumen(t=2.301-12.462,P<0.05).Follow-up at 3.0 years showed internal leakage in 24 patients(8.2%),retrograde type A dissection in 16 patients(5.4%),death due to pseudolumen rupture in 15 patients(5.1%),stent thrombosis in 9 patients(3.1%),paraplegia in 7 patients(2.4%),and distal dissection re-rupture or reoperation in 6 patients(2.0%).Compared with the good prognosis group,the poor prognosis group had a significantly higher proportion

关 键 词：动脉瘤 夹层 药物洗脱支架 血管成形术 高海拔 治疗结果 预后 影响因素分析 

分 类 号：R543.16[医药卫生—心血管疾病] R654.3[医药卫生—内科学]