急性B型主动脉夹层分类差异对腔内修复术疗效及安全性的影响

Clinical Efficacy and Safety of Different Types of Acute Type B Aortic Dissection Undergoing Thoracic Endovascular Repair

目的探讨急性B型主动脉夹层分类差异对体外开窗腔内修复术(thoracic endovascular repair,TEVAR)的疗效及安全性的影响。方法选取我院2013年3月—2015年3月收治的复杂型急性B型主动脉夹层病人37例设为复杂组,将同期非复杂型急性B型主动脉夹层病人48例设为非复杂组,均采用TEVAR术治疗。比较两组30 d死亡率、围术期并发症发生率、二次干预率、动脉扩张率、假腔消失率、手术前后最大动脉直径水平及随访生存率等。结果两组30 d死亡率、围术期并发症发生率、二次干预率、动脉扩张率及假腔消失率比较差异无统计学意义(P>0.05);复杂组术后6个月和12个月最大动脉直径均显著高于术前(P<0.05);且复杂组术后同一时间点最大动脉直径均显著高于非复杂组(P<0.05);非复杂组手术前后最大动脉直径比较差异无统计学意义(P>0.05);同时两组随访生存率比较差异无统计学意义(P>0.05)。结论 EVAR治疗复杂型和非复杂型急性B型主动脉夹层在围术期并发症风险和随访生存率方面效果较为接近;但其用于非复杂型急性B型主动脉夹层病人治疗更有助于促进动脉管腔重塑。

Objective To investigate the clinical efficacy and safety of different types of acute type B aortic dissection(ATBAD) undergoing thoracic endovascular repair(TEVAR). Methods Thirty-seven patients with complicated ATBAD from March 2013 to March 2015 were chosen as group A,and 48 patients with non-complicated ATBAD were as group B.The patients underwent TEVAR.The 30-day mortality,the incidence of perioperative complication,secondary intervention rate,arterial dilatation rate,and false lumen disappearance rate,and maximum arterial diameter before and after surgery,as well as survival rate of follow-up were compared between the two groups. Results There was no significant difference in the 30-day mortality,the incidence of perioperative complication,arterial dilatation rate,false lumen disappearance rate between two groups( P >0.05).The maximum arterial diameters at 6 and 12 months after surgery were significantly higher than that of preoperation( P <0.05),which was significantly higher in group A at the same time point than that in group B( P <0.05).There was no significant difference in the maximum arterial diameter before and after surgery in group B( P >0.05).There was no significant difference in the survival rate with follow-up between two groups( P >0.05). Conclusion TEVAR for different types of ATBAD is similar in the risk of perioperative complications and follow-up survival rate.TEVAR is more helpful to promote arterial lumen remodeling in patients with non-complicated ATBAD.