Stanford B型主动脉夹层治疗的临床观察

Clinical observation of Stanford type B aortic dissection treatment

目的探讨Stanford B型主动脉夹层适宜的治疗方案。方法回顾性分析天津医科大学总医院2008年5月—2013年3月51例Stanford B型主动脉夹层患者临床资料,并通过回访评价患者生存及康复情况。依照是否行胸主动脉覆膜支架隔绝术(TEVAR),分为支架组40例及保守组11例。结果 40例患者TEVAR手术全部成功,围手术期死亡2例(5%),随访期间无死亡患者;11例保守治疗患者院内死亡1例(9.1%),随访期间死亡7例(63.6%)。K-M生存曲线分析显示支架组2年生存率明显高于保守组。支架组术后主动脉及假腔最大直径呈减小趋势且假腔血栓化。结论对于Stanford B型主动脉夹层患者,TEVAR治疗成功率高,促进主动脉真假腔重塑,相对传统内科保守治疗可以显著提高患者生存率、近中期效果好。

Objective To explore the optimal treatment options of Stanford type B aortic dissection. Methods A to-tal of 51 patients with Stanford type B aortic dissection who visited the General Hospital of Tianjin Medical University from May 2008 to March 2013 were analyzed retrospectively. Survival and recovery of patients were evaluated by follow ups. Pa-tients were divided to TEVAR group（40 cases）and conservative group（11 cases）according to the treatment they recieved. Results Operations were successful in all 40 patients. There were two cases of perioperative death（5%）. And none of pa-tients died in TEVAR group during follow-up. One case among 11 patients who received conservative treatment dead in hos-pital（9.1%）while other 7 cases died during follow-up（63.6%）. Kaplan-Meier survival curve showed that two-year survival rate of TEVAR group was significantly higher than that of conservative group. In TEVAR group, the maximum diameter of the aorta presented a decreasing trend and thrombosis was seen in artificial lumen with time going after operation. Conclu-sion For patients with Stanford type B aortic dissection, TEVAR presented a high success rate and promoted remodeling of the aortic genuine and aritificial lumen. What’s more, it can significantly improve patient’s survival rate and recovery in short or mid-term period compared with effect of traditional conservative treatment.