急性B型主动脉夹层的腔内修复治疗

Endovascular Repair for Acute Type B Aortic Dissection

目的总结分析125例急性B型主动脉夹层腔内修复的临床经验。方法回顾性分析2005年1月1日至2014年12月31日北京协和医院血管外科行主动脉腔内修复术（TEVAR）治疗急性B型主动脉夹层患者125例,临床数据包括发病特点、手术方式、围手术期结果和随访结果。结果 125例患者均成功植入主动脉覆膜支架,共植入支架135枚。13例覆盖左侧锁骨下动脉、16例重建左侧锁骨下动脉、10例行内脏动脉重建。全组无围手术期死亡,主要并发症包括单侧肾梗死1例;肾动脉出血2例;脑梗死2例;心肌梗死1例;肾功能障碍2例,其中1例导致永久透析;切口和穿刺部位并发症5例。全组平均住院花费（112 657±58 921）元,其中复杂性夹层的住院花费显著高于非复杂性夹层的患者[（171 623±93 635）元比（92 531±48 721）元,P〈0.001]。全组患者除14例（11.2%）失访,其余患者随访3-120个月,平均（23.5±11.2）个月,随访期内共有3例死亡,其中1例在术后1年死于夹层破裂,2例分别因脑血管意外和肿瘤死亡。随访中无再次干预病例。结论急性主动脉夹层的腔内治疗安全有效。尽管治疗费用更高,复杂性主动脉夹层的急诊手术同样可以获得满意的治疗结果。

Objective To report experience and result of endovascular repair for acute type B aortic dissection（ ATBD）. Methods Totally 125 ATBD patients receiving endovascular repair with stent-graft were enrolled in this study. Demographic data,operation details,perioperative findings,and follow-up results were retrospectively analyzed. Results All the 125 patients were successfully implanted with 135 stent-grafts. Thirteen cases were covered left subclavian artery,16 cases underwent left subclavian artery revascularization,and10 cases underwent visceral artery revascularization. No perioperative mortality occurred. Meanwhile,the perioerative major adverse events included renal infarction（ n = 1）,renal artery bleeding（ n = 2）,stroke（ n = 2）,myocardial infarction（ n = 1）,and renal dysfunction（ n = 2; one of them suffered from permanent dialysis）,and incision complication（ n = 5）. The mean cost during hospital stay was（ 112 657 ± 58 921） Yuan; more specifically, the cost for complicated dissection cases was significantly higher than uncomplicated cases[（171 623 ± 93 635） Yuan vs.（92 531 ± 48 721） Yuan,P〈0.001]. All the patients received regular follow-up for 3-120 months [mean（ 23. 5 ± 11. 2） months],except that 14 cases（ 11. 2%） lost to follow-up.During the follow-up,three deaths were reported,among whom one died due to rupture of distal dissection one year after primary operation. No re-intervention case was noted. Conclusions Endovascular repair for ATBD is safe and feasible. Emergency repair for complicated ATBD cases can get satisfactory results,although the medical cost is higher than uncomplicated cases.