腔内修复术治疗多破口StanfordB型胸主动脉夹层的临床研究

Clinical studying of thoracic endovascular aortic repair for treating multiple tears Stanford type B thoracic aortic dissection

目的分析多破口3StanfordB型胸主动脉夹层的临床特征，探讨胸主动脉腔内修复术处理该病的临床方式。方法回顾性分析2011年2月-2015年5月因多破口（≥2个破口）StanfordB型胸主动脉夹层在广州军区武汉总医院心胸外科接收TEVAR治疗患者的病例资料，除近心端第一破口外，使用外科方式处理远端夹层破口为处理组，否则为非处理组。比较两组术后6个月内胸背疼痛发病率、远端夹层进展情况、假腔变化情况、远端破口获益情况。结果检索出符合条件的病例67例，所有腔内修复术均获成功，无严重并发症发生病例，术后6个月内无死亡病例。处理组7例，非处理组60例。TEVAR后两组胸背疼痛发病率、远端夹层进展发病率差异无统计学意义（P〉0．05），处理组夹层假腔较非处理组明显变小（差异有统计学意义，P〈0．05），非处理组19例患者通过夹层远端破口的血流供应腹腔内脏动脉。结论TEVAR是治疗多破口StanfordB型胸主动脉夹层有效的手术方式，远端破口应根据StanfordB型胸主动脉夹层特点进行个性化处理或尽量不处理。

Objective This study aims to analysis in the clinical features of Stanford type B thoracic aortic dis- section with multiple tears, and to explore the clinical methods of thoracic endovascular aortic repair （TEVAR） treating this disease. Methods From February 2011 to May 2015, the cases that diagnosed with multiple tears （ ≥ two tears） Stanford type B thoracic aortic dissection and accepted operations with TEVAR at department of Tho- racic Cardiovascular Surgery, Wuhan General Hospital of Guangzhou Command, were retrospective analyzed their clinical data. Except the first tear of proximal, cases were named for the treatment group whom used surgical meth- ods treating distal aortic dissection tears. Otherwise, the cases were named non-treatment group. We compared the incidence of chest and back pain, the progress of distal aortic dissection, the changes of false lumen with aortic dis- section, and the benefit of distal tears in two groups after 6 months after TEVAR. Results A total of 67 cases were recruited this retrospective study, successful operations with TEVAR were conducted in all patients, and no serious complications occurred postoperatively in all patients. 7 cases with treatment group, 60 cases with non-treatmentgroup, no deaths within two groups in 6 months after TEVAR. There were no significance statistically in complained of the incidence of chest and back pain, and the rate of progress with distal aortic dissection （P 〉 0.05 ）. There was statistically significant in the rate of changes with false lumen with aortic dissection false lumen （ P 〈 0.05 ）. Some cases with abdominal visceral artery, blood flow from the distal tears of aortic dissection in the non-treatment （n = 19）. Conclusions TEVAR is an effective method for treating multiple tears Stanford type B thoracic aortic dissection. Distal tears should be individualized treatment according to the characteristics of Stanford type B thoracic aortic dissection or try not to deal with.