Stanford B型主动脉夹层撕裂不同形态患者临床特点及主动脉腔内修复术疗效观察

Clinical characteristics of Stanford B aortic dissection different tearing morphology and effect of aortic endovascular repair

目的探讨Stanford B型主动脉夹层撕裂不同形态患者的临床特点及主动脉腔内修复术的疗效。方法选取自2003年2月至2017年6月沈阳军区总医院心血管内科收治的行主动脉腔内修复术治疗的472例Stanford B型主动脉夹层患者为研究对象,根据主动脉增强CT+三维重建将夹层撕裂形态分为螺旋形撕裂走行组(螺旋组)与非螺旋形撕裂走行组(非螺旋组),比较两组患者的临床特点及行主动脉腔内修复术后围术期及36个月的疗效。结果两组患者胸闷痛、背痛、腹痛、心包积液、胸腔积液等临床症状比较,差异均无统计学意义(P> 0. 05)。螺旋组心胸比值、假腔大于真腔患者比例、破口数、累及肾动脉与髂动脉患者比例均高于非螺旋组,破口距左锁骨下动脉≥15 mm患者比例低于非螺旋组,两组间比较,差异均有统计学意义(P <0. 05)。螺旋组完全封闭左锁骨下动脉开口比例明显高于非螺旋组,覆膜支架数少于非螺旋组,支架近、远端直径长于非螺旋组,两组间比较,差异均有统计学意义(P <0. 05)。本组472例患者中,465例出院患者均获得36个月的随访。随访期间,两组患者疼痛、左上肢跛臂及新发心脑血管疾病等情况比较,差异均无统计学意义(P>0. 05)。结论夹层撕裂走行形态不同对患者临床症状、术后并发症及远期预后无影响。螺旋形撕裂的降主动脉夹层累及肾动脉与髂动脉多、破口数多、支架直径大、支架数少。

Objective To investigate the clinical characteristics of patients with different aortic dissection tearing morphology and the analysis of the curative effect of aortic endovascular repair in patients with Stanford B aortic dissection.Methods A retrospective study was performed on 472 cases of patients with Stanford B aortic dissection who were admitted and underwent aortic endovascular repair from February 2003 to June 2017.According to the different tearing morphology,there were spiral tear group and non-spiral tear group,to access clinical features,in-hospital and late outcomes during follow-up for 3 years.Results The clinical symptoms of chest tightness,backache,abdominal pain,pericardial effusion and pleural effusion in the two groups were not statistically significant(P>0.05).The comparison of patients with the thoracic ratio of the spiral group,the proportion of patients with the false cavity greater than the true cavity,the number of ruptures,the cumulative renal artery,iliac artery were higher than those of the non-spiral group,while the patients of the rupture distance from the left subclavian artery greater than 15 mm were lower than the non-spiral group,and the difference was statistically significant(P<0.05).The proportion of total closed left subclavian artery openings in the spiral group was significantly higher than that in the non-spiral group,the number of laminated stent was less than that in the non-spiral group,and the diameter of the proximal and distal end of the stent was longer than that in the non-spiral group.The difference between the two groups was statistically significant(P<0.05).Among the 472 patients in this study,465 were followed up for 36 months.During the follow-up,there were no statistically significant differences between the two groups in terms of pain,left upper limb claudication and new-onset cardiovascular and cerebrovascular diseases(P>0.05).Conclusion There is no effect on the clinical symptoms,postoperative complications or long-term prognosis of the patients.The number of arterial iliac arteries,the number of ruptures,the diameter of stents,and the number of stents are mostly involved in the descending AD of helical tears.