胸主动脉腔内修复术后内脏动脉段残余裂口数量与血管重塑的关系  

Relationship between the number of residual tears in visceral artery segment and vascular remodeling after endovascular repair of thoracic aorta

作　　者：王晓通 陈量 姚勇 Wang Xiaotong;Chen Liang;Yao Yong(Department of Cardiovascular Surgery,Qianxinan People's Hospital,Xingyi 562400,China)

机构地区：[1]黔西南州人民医院心脏血管外科,贵州兴义562400

出　　处：《中华胸心血管外科杂志》2025年第3期168-176,共9页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探究胸主动脉腔内修复术(TEVAR)后内脏动脉段残余裂口数量与血管重塑的关系。方法回顾性收集2018年6月至2023年6月于黔西南州人民医院确诊为复杂Stanford B型主动脉夹层(cTBAD)并接受治疗的患者100例为研究对象;根据预后情况,分为良性重塑组(58例)和非良性重塑组(42例)。比较两组患者临床资料、手术前后影像学指标、术后早期形态学特征。通过多因素logistic分析术后内脏动脉重塑情况的独立影响因素。采用Cox比例风险回归分析不同疾病分期下内脏动脉段残余裂口数量与非良性重塑的关联分析。应用样条函数与logistic回归相结合的限制性立方样条法分析内脏动脉段残余裂口数量与非良性重塑的关系。结果与良性重塑组相比,非良性重塑组患者年龄显著增加、疾病分期显著加重(P<0.05);术后腹腔干(CAT)、肠系膜上动脉(SMA)、左侧肾动脉(LRA)、右侧肾动脉(RRA)平面真腔直径和面积,LRA平面假腔直径,CAT、SMA平面血栓面积,CAT、SMA、LRA真腔直径显著增加(P<0.05),CAT、SMA、LRA假腔直径,SMA、LRA血栓直径显著降低(P<0.05);术后早期假腔最大直径、内脏动脉段残余裂口数量、腰动脉发自假腔数量均显著增加(P<0.05)。进一步多因素logistic回归分析结果显示,年龄、疾病分期、CAT和SMA的平面真腔面积和平面血栓面积、LRA和RRA的平面真腔面积、内脏动脉段残余裂口数量均是术后内脏动脉重塑情况的独立影响因素。Cox比例风险回归分析显示不同疾病分期下内脏动脉段残余裂口数量与非良性重塑显著相关,在年龄≤58.7岁和>58.7岁人群中,内脏动脉段残余裂口数量与疾病分期的相乘交互项P值分别为0.028和0.031。限制性立方样条分析显示无论年龄、疾病分期,内脏动脉段残余裂口数量与非良性重塑关联强度呈非线性剂量-反应关系,内脏动脉段残余裂口数量≥2,非良性重塑风险显著增�ObjectiveTo investigate the relationship between the number of residual tears in visceral artery segment and vascular remodeling after thoracic aortic endovascular repair(TEVAR).MethodsA total of 100 patients diagnosed with complicated Stanford type B aortic dissection(cTBAD)and treated with TEVAR in our hospital from June 2018 to June 2023 were collected retrospectively as study objects,and were divided into benign remodeling group(58 cases)and non-benign remodeling group(42 cases)according to prognosis.The clinical data,imaging indexes before and after operation,and early postoperative morphological characteristics were compared between the two groups.The independent influencing factors of internal artery remodeling after operation were analyzed by multivariate logistic analysis.Cox proportional risk regression was used to analyze the association between the number of residual tears in visceral artery segments and non-benign remodeling at different disease stages.The relationship between the number of residual tears and non-benign remodeling of visceral artery segments was analyzed by the restricted cubic spline method combined with spline function and logistic regression.ResultsCompared with the benign remodeling group,the age and disease stage of the non-benign remodeling group were significantly increased(P<0.05).After operation,the diameter and area of celiac trunk(CAT),superior mesenteric artery(SMA),left renal artery(LRA)and right renal artery(RRA)were significantly increased(P<0.05),while the diameter and area of CAT,SMA and LRA were significantly decreased(P<0.05).The maximum diameter of the lumen,the number of residual lacerations in the visceral artery segment and the number of lumen originating from the lumbar artery were significantly increased(P<0.05).Further logistic regression analysis showed that age,disease stage,plane true lumen area and plane thrombus area of CAT and SMA,plane true lumen area of LRA and RRA,and number of residual tears of visceral artery segment were independent factors influ

关 键 词：胸主动脉腔内修复术 内脏动脉段残余裂口数量 血管重塑 

分 类 号：R654.3[医药卫生—外科学]