贵州医科大学学报

2018, v.43;No.216(09) 1079-1083

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血管腔内修复术治疗Standford B型主动脉夹层临床疗效
Clinical Efficacy of Endo-vascular Aortic Repair in the Treatment of Standford Type B Aortic Dissection

陈豪;刘勇;伍成文;王征;
CHEN Hao;LIU Yong;WU Chengwen;WANG Zheng;Department of Vascular Surgery,Affiliated Hospital of Southwestern Medical University;

摘要(Abstract):

目的:观察主动脉腔内修复术(TEVAR)治疗Standford B型主动脉夹层(TBAD)的临床疗效。方法:80例TBAD患者行TEVAR手术治疗,记录患者术后1月内及术后1~6个月内再次行相关手术例数、死亡率及并发症发生率,比较术前、术后1月及6月时TBAD患者主动脉峡部段、降主动脉中段、降主动脉远段、腹主动脉腹腔干段及分叉段的真、假腔管径,比较术后1月及6月时TBAD患者主动脉峡部段、降主动脉中段、降主动脉远段、腹主动脉腹腔干段及分叉段的真、假腔血栓化情况。结果:术后1个月内,再次行相关手术3例(3. 8%),主要并发症发生率12. 5%,因突发主动脉破裂死亡1例(1. 25%);术后1~6个月,再次相关手术4例(5. 08%),主要并发症发生率15. 2%,患者均存活;术后1月及6月时,主动脉峡部段、降主动脉中段、降主动脉远段真腔管径均较术前逐渐增大,假腔管径则均较术前逐渐减小(P <0. 05);腹主动脉腹腔干段和分叉段真腔管径均较术前逐渐增大(P <0. 05),假腔管径与术前比较,差异无统计学意义(P> 0. 05);术后6月时主动脉峡部段、降主动脉中段及降主动脉远段假腔血栓化患者比例高于术后1个月时(P <0. 05);术后1月及6月时腹主动脉腹腔干段与分叉段假腔血栓化患者比例比较,差异无统计学意义(P> 0. 05)。结论:TEVAR治疗TBAD并发症少、随访病死率低,术后患者主动脉各段真假腔管径改善情况及假腔血栓化情况良好。
Objective: To observe the clinical efficacy of thoracic endovascular aortic repair( TEVAR) in the treatment of Standford type B aortic dissection( TBAD). Methods: The clinical data of80 TBAD patients received TEVAR were retrospectively analyzed. The surgical status was observed,including: number of relevant surgery,the mortality rate and the incidence rate of complications within1 to 6 months after operation; comparing following data of TBAD patients before surgery,1 month and6 months after surgery: tube diameter of aortic isthmus segment,middle section of aorta descendens,distal section of aorta descendens,true and false lumen of celiac trunk and bifurcation segment of abdominal aorta; comparing thrombosis condition of aortic isthmus segment,middle section of aorta descendens,distal section of aorta descendens,true and false lumen of celiac trunk and bifurcation segment of abdominal aorta. Results: Within 1 month after operation,3 cases( 3. 8%) received related operation,and the incidence rate of main complications was 12. 5%,and 1 case( 1. 25%) died due to aortic rupture. 1 to 6 months after operation,4 cases( 5. 08%) received related operation,and the incidence rate of main complications was 15. 2%,and all patients survived. 1 month and 6 months after operation,the diameters of true lumen in aortic isthmus segment,middle section of aorta descendens,distal section of aorta descendens,while false lumen were all gradually decreased compared with before surgery( P < 0. 05); true lumen of celiac trunk and bifurcation segment of abdominal aorta increased compared with before surgery( P < 0. 05),and false lumen showed no significant difference compared with before surgery( P > 0. 05). Thrombosis condition of false lumen of aortic isthmus segment,middle section of aorta descendens,distal section of aorta descendens after 6 months of surgery were higher than 1 month after surgery( P < 0. 05). There was no significant difference in thrombosis conditions of false lumen in the celiac trunk segment and the abdominal aortic bifurcation segment between 1 moth after operation and 6 months after operation( P > 0. 05). Conclusions: TEVAR in the treatment of TBAD has the advantages of less complications and low fatality rate. After operation,patients can have good improvement of the true and false lumens diameters of aorta and the thrombosis of false lumens.

关键词(KeyWords): 胸主动脉腔内修复术;Standford B型主动脉夹层;疗效;主动脉各段真假腔管径;假腔血栓化
thoracic endovascular aortic repair;standford type B aortic dissection;efficacy;true and false lumens diameters of aorta segment;thrombosis of false lumens

Abstract:

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基金项目(Foundation): 国家自然科学基金资助项目(81270358)

作者(Author): 陈豪;刘勇;伍成文;王征;
CHEN Hao;LIU Yong;WU Chengwen;WANG Zheng;Department of Vascular Surgery,Affiliated Hospital of Southwestern Medical University;

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