Stanford B型主动脉夹层患者胸主动脉腔内修复术后主动脉重塑的影响因素分析  

Analysis of influencing factors on aortic remodeling after thoracic endovascular aortic repair in Stanford type B aortic dissection patients

作　　者：阿依别克·乃比[1] 叶尔买克·唐沙哈尔[1] 郭永忠[1] Aybek·Nabi;Ermek·Tangsakar;Guo Yongzhong(Center for Cardiac and Pan-Vascular Medicine,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,Xinjiang,China)

机构地区：[1]新疆维吾尔自治区人民医院心脏及泛血管医学诊疗中心,新疆乌鲁木齐830001

出　　处：《血管与腔内血管外科杂志》2025年第3期295-299,305,共6页Journal of Vascular and Endovascular Surgery

基　　金：新疆维吾尔自治区自然科学基金项目(2022D01C132)。

摘　　要：目的探讨Stanford B型主动脉夹层患者胸主动脉腔内修复术(TEVAR)后主动脉重塑的影响因素。方法收集2021年1月至2023年12月于新疆维吾尔自治区人民医院行TEVAR治疗的150例Stanford B型主动脉夹层患者的临床资料。术后随访6个月,根据主动脉重塑情况将患者分为重塑良好组(n=95)和重塑不良组(n=55)。收集所有患者的一般资料、影像学特征、手术相关指标以及随访资料,采用多因素Logistic回归模型分析Stanford B型主动脉夹层患者TEVAR术后主动脉重塑的影响因素。结果重塑不良组患者的年龄大于重塑良好组患者,高血压病史的比例高于重塑良好组患者,差异均有统计学意义(P﹤0.05)。与主动脉重塑良好组患者相比,主动脉重塑不良组患者的夹层累及范围更广,假腔血栓形成不全的比例更高,真腔最小直径更小,假腔最大直径更大,夹层发病至手术的时间更长,术中覆盖长度更短,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,年龄较大、夹层发病至手术的时间长、假腔血栓形成不完全、术中覆盖长度不足均是Stanford B型主动脉夹层患者TEVAR术后主动脉重塑的独立危险因素(P﹤0.05)。结论Stanford B型主动脉夹层患者TEVAR术后主动脉重塑过程受到多种复杂因素的共同影响,术前应充分评估患者情况,合理选择手术时机和策略,从而提高手术效果,改善患者长期预后。Objective To investigate the influencing factors on aortic remodeling after thoracic endovascular aortic repair(TEVAR)in Stanford type B aortic dissection.Method The clinical data of 150 Stanford type B aortic dissection patients treated with TEVAR in People's Hospital of Xinjiang Uygur Autonomous Region from January 2021 to December 2023 were collected.After 6-month follow-up,the patients were divided into good remodeling group(n=95)and poor remodeling group(n=55)based on their aortic remodeling status.The general data,imaging features,surgical related indicators and follow-up data of all patients were collected.The influencing factors on aortic remodeling after TEVAR in Stanford type B aortic dissection using multiple Logistic regression model.Result The age of patients in the poor remodeling group was older than that in the good remodeling group,and the proportion of patients with a history of hypertension was higher than that in the good remodeling group,the differences were statistically significant(P<0.05).Compared with patients in good remodeling group,patients in poor remodeling group had a wider range of dissection involvement,a higher proportion of incomplete formation of false lumen thrombosis,a smaller minimum diameter of the true lumen,a larger maximum diameter of the false lumen,a longer time from dissection onset to surgery,and a shorter intraoperative coverage length,the differences were statistically significant(P<0.05).The results of multivariate analysis showed that older age,longer time from onset of dissection to surgery,incomplete formation of false lumen thrombus,and insufficient intraoperative coverage were independent risk factors for aortic remodeling after TEVAR in Stanford type B aortic dissection patients(P<0.05).Conclusion Aortic remodeling in Stanford type B aortic dissection patients after TEVAR surgery is affected by many factors.The patient's condition should be fully evaluated before surgery,and the surgical timing and strategy should be reasonably selected to improve the surgic

关 键 词：Stanford B型主动脉夹层 胸主动脉腔内修复术 主动脉重塑 影响因素 

分 类 号：R543[医药卫生—心血管疾病]