胸腔血管内主动脉修复术治疗急性Stanford B型主动脉夹层的单中心治疗经验  

Experience in the single-center treatment of acute Stanford type B aortic dissection with thoracic endovascular aortic repair

作　　者：戴一笑 史书茗 戎建杰 Dai Yixiao;Shi Shuming;Rong Jianjie(Department of Vascular Surgery,Nanjing University of Traditional Chinese Medicine Affiliated Suzhou Hospital of Traditional Chinese Medicine,Suzhou 215000,Jiangsu,China)

机构地区：[1]南京中医药大学附属苏州市中医医院血管外科,江苏苏州215000

出　　处：《血管与腔内血管外科杂志》2025年第3期319-322,327,共5页Journal of Vascular and Endovascular Surgery

基　　金：苏州市卫生健康委员会临床重点病种诊疗技术专项项目(LCZX202214);苏州市科学技术局科技创新项目(SKY2021011);苏州市科学技术局医工结合协同创新研究项目(SLJ2022024)。

摘　　要：目的探讨胸腔血管内主动脉修复术(TEVAR)治疗急性Stanford B型主动脉夹层(ATBAD)的有效性、安全性及可行性。方法收集2020年1月至2023年12月南京中医药大学附属苏州市中医医院收治的12例ATBAD患者的临床资料,均进行TEVAR治疗,比较手术前后患者的相关指标以及随访情况。结果12例ATBAD患者均成功完成TEVAR术,术后即刻造影未见夹层显影,影像学表现良好,技术成功率100%,手术成功率100%,平均手术时间(2.29±0.85)h,平均手术出血量(133.33±65.13)ml。术后24 h,血红蛋白(HGB)、高敏肌钙蛋白(hs-TnI)均低于术前,D-二聚体(D-D)高于术前,手术前后比较,差异均有统计学意义(P﹤0.05)。12例ATBAD患者均顺利出院并随访,平均住院时间为(18.08±1.02)d,平均随访时间为17.70(6.33,30.00)个月,随访期间所有患者均未诉出现胸闷、背痛等不适,1年后复查计算机断层扫描血管成像(CTA)示支架形态良好,管腔通畅,未见夹层。结论TEVAR治疗ATBAD疗效显著,患者症状缓解明显,安全性较高,手术成功率较高,需根据患者的具体情况进行个体化的分析,积极处理并发症。Objective To investigate the efficacy,safety and feasibility of thoracic endovascular aortic repair(TEVAR)in the treatment of acute Stanford type B aortic dissection(ATBAD).Method Clinical data of 12 ATBAD patients admitted to Nanjing University of Traditional Chinese Medicine Affiliated Suzhou Hospital of Traditional Chinese Medicine from January 2020 to December 2023 were collected,all of whom were treated with TEVAR.The relevant indicators and follow-up of patients before and after surgery were compared.Result All of the 12 ATBAD patients successfully completed TEVAR surgery,and no dissection was observed immediately after the operation.The imaging performance was good,the technical success rate was 100%,the surgical success rate was 100%,the average operative time was(2.29±0.85)h,and the average amount of surgical bleeding was(133.33±65.13)ml.At 24 h after surgery,hemoglobin(HGB)and hypersensitive troponin(hs-TnI)were lower than before surgery,and D-dimer(D-D)was higher than before surgery,the differences were statistically significant(P<0.05).All of the 12 ATBAD patients were discharged successfully and followed up,the average hospital stay was(18.08±1.02)d and the average follow-up time was 17.70(6.33,30.00)months.During the follow-up period,none of the patients complained of chest tightness,back pain and other discomfort,and computed tomography angiography(CTA)examination one year later showed good stent shape.The lumen was clear,no dissection was seen.Conclusion TEVAR is effective in the treatment of ATBAD,with obvious symptom relief,high safety and high surgical success rate.It is necessary to conduct individualized analysis according to the specific conditions of patients and actively manage complications.

关 键 词：急性Stanford B型主动脉夹层 支架 主动脉腔内隔绝修复术 

分 类 号：R543[医药卫生—心血管疾病]