急性Stanford B型主动脉夹层腔内修复治疗的疗效评价

Clinical follow-up of thoracic endovascular aortic repair in treatment of acute Stanford B dissection

目的:评价腔内修复术(TEVAR)治疗急性Stanford B型主动脉夹层的中、远期疗效。方法:2001年12月~2009年6月,对急性Stanford B型主动脉夹层进行血管腔内支架植入治疗患者288(男237,女51)例,年龄21~79(平均51.2)岁。局部或全身麻醉,在X线透视下将支架型人工血管经股动脉放置在主动脉夹层第1裂口位置,实现腔内修复。应用多排CT等技术进行38个月(6~102月)的随访,观察假腔血栓形成情况、有无内漏、血流动力学变化、移植物位置及形态、内脏动脉供血等情况,评估该方法的安全性及有效性。结果:全组患者无移植物错放、移位、瘤体破裂、中转手术和截瘫等并发症。围术期死亡6例,分别为:腹腔脏器缺血/再灌注损伤2例、升主动脉逆行夹层1例、夹层破裂1例、心肌梗死1例及死亡原因不明1例。住院期间并发症发生率25.3%,包括术后即刻内漏、发热、肾功能不全、切口感染、肺炎、神经系统并发症、心功能不全、左肱动脉假性动脉瘤、截肢等。随访中共有7例死亡(2.4%),4例患者行二次TEVAR术后治愈。Kaplan-Meier生存曲线显示5年累积生存率达96%。结论:TEVAR术是治疗急性Stanford B型主动脉夹层的一种有效方法,中期疗效满意,患者远期生存状况良好。

AIM： To evaluate the mid-term results of thoracic endovascular aortic repair （TEVAR） in treatment of acute Stanford B dissection. METHODS ： From December 2001 to June 2009, 288 patients （237 males, 51 females; average age 51.2 years） with acute Stanford B dissection were enrolled in our institution and received TEVAR. Stent grafts were placed to exclude primary tear of dissection under general or local anesthesia. All patients were followed-up by multisliced CT for an average of 38 months （6 - 102 months）. Thromhus formation of false lumen, presence of endoleak, hemodynamic changes, position and shape of the stent graft, and blood supply of visceral vessels were all evaluated. RESULTS ： All stent grafts were placed in the desired position and no migration, dissection rupture, conversion or paraplegia were observed during TEVAR. There were six perioperative deaths. Two patients died due to ischemia-reperfusion syndrome, one died due to retrograde Stanford A dissection, one due to rupture of dissection, one due to myocardial infarction and one without obvious reasons. Perioperative complications （25.3%） included instant endoleak, fever, renal insufficiency, infection, pneumonia, central nervous system disorder, cardiac insufficiency, pseudo-aneurysm and amputation. There were seven deaths during the follow-up period and four patients received reintervention. Kaplan-Meier curve showed an estimated 5-year survival rate of 96%. CONCLUSION： TEVAR is less invasive, s^e and feasible as an effective method in treatment of acute Stanfi）rd B dissection and produces good mid-term results.