Stanford B型主动脉夹层原发破口位置对腹腔主要分支血流灌注的影响

Impact of initial intimal tear position on perfusion of abdominal branches in Stanford B aortic dissection

目的探讨Stanford B型主动脉夹层原发破口位置对腹腔主要分支动脉血流灌注的影响。方法回顾性分析130例Stanford B型主动脉夹层患者术前主动脉CTA资料,对受累的腹腔主要分支血管(腹腔干、肠系膜上动脉、双侧肾动脉)缺血类型和灌注损伤程度进行分型,并分析二者与不同夹层原发破口位置的关系。结果 130例患者共计542支分支动脉中,465支(465/542,85.79%)存在缺血,包括337支(337/542,62.18%)动力型缺血及128支(128/542,23.62%)静力型缺血,其中灌注受损69支(69/542,12.73%)、灌注未受损396支(396/542,73.06%);77支(77/542,14.21%)血管无缺血。灌注受损的分支血管中,动力型缺血37支(37/69,53.62%),静力型缺血32支(32/69,46.38%),差异无统计学意义(χ~2=3.077,P=0.215)。夹层原发破口位置对腹腔主要分支动脉缺血类型(动力型、静力型)及灌注改变情况(受损、未受损)无明显影响(χ~2=1.352、0.776,P=0.509、0.678)。结论 B型主动脉夹层原发破口的位置对腹腔主要分支动脉缺血类型及灌注损伤程度无明显影响,评估腹腔主要分支血管缺血及灌注改变情况对指导手术方案制定有重要临床意义。

Objective To explore the influence of different initial intimal tear positions on abdominal branch perfusion in Stanford B aortic dissection. Methods CTA data of 130 patients with Stanford B aortic dissection were reviewed retrospectively. The involved aortic branches （celiac trunk, superior mesenteric artery, bilateral renal artery） were classified into different types according to the degree of ischemia and perfusion damage, and their relationship with different initial intimal tear positions were also analyzed. Results There were 542 branches in 130 patients, in which 465 branches （465/542, 85.79%） were ischemic, including 337 branches （337/542, 62.18%） of dynamic ischemia and 128 branches （128/542, 23.62%） of static ischemia, 77 branches （77/542, 14.21%） without ischemia. In ischemic branches, the perfusion in 69 （69/542,12.73%） of them were impaired and those of the other 396 branches （396/542, 73.06%） were unimpaired. In all of the 69 branches of impaired perfusion, 37 branches （37/69, 53.62%） were dynamic ischemia and 32 branches （32/69, 46.38%） were static ischemia, and the difference was no statistically significant （χ2=3.077, P=0.215）. Furthermore, no significant impact was found in initial intimal tear positions on ischemic patterns （dynamic and static） or perfusion patterns （unimpaired and impaired; χ2=1.352, 0.776, P=0.509, 0.678）. Conclusion Initial intimal tear positions has no significant impact on ischemia pattern or perfusion pattern of abdominal aortic branches. The evaluation of abdominal aortic branches is helpful for guiding surgery.