150例A型主动脉夹层患者解剖参数及其临床意义分析

Anatomic data and clinical significance analysis of 150 cases of type A aortic dissection

目的分析Stanford A型主动脉夹层患者术前主动脉解剖参数与患者手术方式及预后的关系。方法 Stanford A型主动脉夹层患者150例,记录患者的临床资料和影像学资料,按手术方式及性别分组。术后3个月对患者进行随访,记录术后3个月的生存率。结果主动脉根部置换组主动脉根部直径为(53.25±13.17)mm,保留主动脉根部组为(49.08±6.94)mm,两组比较差异有统计学意义(P<0.05);生存率分别为86.84%和79.79%,两组比较差异无统计学意义(P>0.05)。主动脉弓及分支的直径与主动脉弓部的手术方式无相关性。主动脉根部置换组和保留主动脉根部组主动脉弓起始处直径分别为(54.47±9.69)mm和(54.48±8.30)mm,主动脉弓直径分别为(31.39±7.14)mm和(32.73±6.59)mm,无名动脉起始处直径分别为(14.65±3.00)mm和(14.28±2.99)mm,左颈总动脉起始处直径分别为(9.81±2.33)mm和(9.56±2.10)mm,左锁骨下动脉起始处直径分别为(11.15±2.84)mm和(11.13±2.56)mm,P均>0.05。A型夹层患者降主动脉参数存在性别差异,男性和女性降主动脉起始处直径分别为(41.09±8.86)mm和(37.44±5.60)mm,降主动脉平行于肺动脉处直径分别为(34.31±0.59)mm和(31.11±0.88)mm,降主动脉在膈肌处直径分别为(31.45±6.50)mm和(28.46±5.20)mm,P均<0.05。结论主动脉根部直径是影响Stanford A型主动脉夹层患者根部手术方式的影响因素之一。在处理A型夹层患者降主动脉时要考虑性别差异。这些数据为覆膜支架的选择和设计提供了数据参考。

Objective To analyse of 150 cases of type A aortic dissection anatomic parameter and the relationship between anatomic parameter and clinic date and prognosis.Methods We identified 150 cases of type A aortic dissection who were diagnosed clearly.All patients were divided into groups by gender and surgical approaches.General clinic data and radiological data were recorded.Survival rate was evaluated by follow up 3 months after surgery.Results The aortic root diameter of group aortic root replacement was（53.25±13.17）mm,group aortic root sparing was （49.08±6.94）mm,there was significant difference between the two group（P〈0.05）;survival rate was 86.84% and 79.79%,respectively.There was no relevance between diameter of aortic arch and branch with the aortic arch surgery way.The starting diameter of two group were （54.47±9.69）mm and（54.48±8.30）mm,the diameter of aortic arch were （31.39±7.14）mm and（32.73±6.59）mm,respectively.The anonymous artery diameter were （14.65±3.00）mm and（14.28±2.99）mm,respectively.The left common carotid artery diameter were（9.81±2.33）mm and（9.56±2.10）mm,respectively.The start diameter of the left subclavian artery were（11.15±2.84）mm and（11.13±2.56）mm（all P〉0.05）.There were gender differences between type A dissection parameters of descending aorta,the start diameter of male and female＇s descending aorta were （41.09±8.86）mm and（37.44±5.60）mm,respectively.The descending aorta in parallel to the pulmonary artery diameter were（34.31±0.59）mm and（31.11±0.88）mm,respectively.Descending aorta diameter of the diaphragm were（31.45±6.50）mm and（28.46±5.20）mm,respectively（all P〉0.05）.Conclusion In patients who suffer from type A aortic dissection,Parameter of aortic root is one of factors which determine surgical approach to aortic root.When treating descending aorta,surgeon should consider the influence of gender.Our study provided data references for selection and design of endovascular stent-graft.