摘要
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.
出处
《中华普通外科杂志》
CSCD
北大核心
2012年第12期988-991,共4页
Chinese Journal of General Surgery
基金
国家自然科学基金资助项目(30471706)
辽宁省教育厅重点实验章基金资助项目(LS2010172)