老年和非老年B型主动脉夹层临床特点及腔内隔绝术临床疗效比较

Comparison of clinical features and effects of endovascular stent-graft repair in elderly and middle-aged patients with Stanford B aortic dissections

目的比较老年和非老年Stanford B型主动脉夹层患者的临床特点及腔内隔绝术的临床疗效。方法 2002年5月至2008年7月,124例B型主动脉夹层住院患者接受腔内隔绝术治疗。根据年龄分为老年组(≥60岁,n=39)与非老年组(<60岁,n=85)。随访1～78个月,平均(25.7±17.3)个月。分析其临床和影像资料。比较两组患者腔内隔绝术的近期和远期疗效。结果与非老年组相比,老年组冠心病、不典型夹层及吸烟比率高,而肥胖、饮酒发病率低。长期随访显示,老年组与非老年组主动脉夹层并发症发生率差异无统计学意义(15.8%vs 10.0%,P=0.36)。长期随访发现,两组合并冠心病者,行覆膜支架联合经皮冠状动脉介入治疗后,并发症发生率差异亦无统计学意义(12.5%vs 10.0%,P=1.00)。结论老年与非老年患者有不同的发病危险因素和临床特点,及时干预危险因素可以降低主动脉夹层的发生。腔内隔绝术治疗B型主动脉夹层安全有效,其术后并发症与患病年龄无关,可以作为主动脉夹层首选治疗方法。

Objective To compare the clinical features of the elderly and middle-aged patients who have been diagnosed with Stanford B aortic dissections, and analyze the therapeutic effects of endovascular stent-graft repair in these patients. Methods From May 2002 to July 2008, totally 124 patients with Stanford B aortic dissection underwent endovascular stent-graft repair. The patients were divided into elderly group （≥60 years old, n=39） and middle-aged group （〈 60 years old, n=85） . Follow-up visit ranged from 1 to 78 months, mean （25.7_＋17.3） months. The clinical data of the patients were collected and analyzed. The short-term and long-term therapeutic effects of endovascular stent-graft repair were compared between the two groups. Results Compared with middle-aged patients, elderly patients had higher incidences of coronary artery disease, atypical dissection, and smoking, while lower incidences of obesity and alcohol drinking, Long-term follow-up visit revealed no difference in complications incidence of aortic dissection between the two groups （15.8% vs 10.0%, P=0.36）. For patients complicated by coronary heart diseases, who received endovascular stent-graft repair combined with percutaneous coronary intervention, postoperative complications incidences were also not significantly different between the two groups （12.5% vs 10%, P=1.00）. Conclusion The risk factors and clinical features of aortic dissection are different between elderly and middle-aged patients. Early intervention of risk factors can decrease aortic dissection incidences. Endovascular stent-graft repair is effective for treatment of Stanford B aortic dissection. The postoperative complications incidence is independent of age. Endovascular stent-graft repair could be the first choice for treatment of aortic dissection both in the elderly and in the uniddle-aged payierds.