急性StanfordB型主动脉夹层腔内修复与保守治疗的疗效比较

Endovascular repair vs conservative therapy for the treatment of acute type B aortic dissection

目的总结急性StanfordB型主动脉夹层疾病（aorticdissection，AD）的临床特点，对比腔内修复治疗（endovascularrepair，EVR）与保守治疗效果。方法回顾性分析2004年1月至2010年10月收治的116例急性StanfordB型AD患者的临床资料，分为EVR组（60例）和保守治疗组（56例），其中EVR组采用覆膜支架植入治疗AD；保守组采用降压镇痛等对症治疗。对2组治疗效果进行统计学评估和比较。结果116例急性StanfordB型AD患者主要临床表现为：胸背部疼痛（74．1％），CTA检查是确诊主动脉夹层的主要手段。保守组56例患者，入院30d死亡率为16．1％；EVR组60例患者，移植物均成功释放，30d死亡率为1．7％明显低于保守组（P〈0．05）。保守组和EVR组随访率分别为71．4％和86．7％，平均随访时间分别为（38±16）个月和（354±14）个月，5年生存率保守组和EVR组分别为87．5％和88．5％，差异无统计学意义（P〉0．05）。结论腔内支架植入治疗是急性StanfordB型主动夹层的首选方法，能够提高患者30d生存率；保守治疗也仍然是一种治疗选择。

Objectives To compare endovascular aortic repair （EVR） and medical therapy for acute type B aortic dissection （AD） in terms of treatment results. Methods From January 2004 to October 2010 116 cases were collected and were divided into two groups, with treatment of EVR （n = 60） and medical therapy （n = 56）. Treatment outcomes were assessed. Results Clinical manifestations of AD are complex and variable, with the most common symptom being pain on chest and back （74. 1% ）. CTA is the most valuable method in confirming the diagnosis of aortic dissection. In conservative group of 56 patients admitted to hospital, 30-day mortality rate was 16. 1%. In EVR group of 60 patients with grafts successfully released, the 30-day mortality was 1.7%. There is significant difference between the two groups on mortality rate during 30-day（ P 〈 0. 05 ）. Follow-up rate in conservative group and the EVR group was 71.4% and 86. 7%, with average follow-up time of （38 ± 16） months and （35 ± 14） months. The 5-year survival rates were 87. 5% and 88. 5% respectively in conservative group and EVR group （P 〉 0.05 ）. Conclusions EVR is considered to be the first choice for acute Stanford type B dissection. EVR can improve patients＇ 30-day survival, though long term result is comparable with that of conservative treatment.