杂交技术治疗B型主动脉夹层258例预后分析

Prognosis of hybrid technique for type B aortic dissection with 258 cases

目的探讨杂交技术治疗B型主动脉夹层(type B aortic dissection,TBAD)的单中心近远期预后。方法回顾性分析2006年1月至2018年8月在广东省人民医院应用杂交技术治疗TBAD的258例患者资料,男性238例(92.2%),年龄(52.4±10.3)岁。主要不良事件定义为全因死亡、再次主动脉手术、卒中、脊髓缺血、主动脉破裂、逆撕A型夹层及血管移植物感染;近期结局定义为术后30 d或院内事件。通过Kaplan-Meier分析评估远期生存率及桥血管通畅率。结果手术成功率98.8%(255/258),近期主要不良事件发生率13.6%(35/258),其中全因死亡18例(7.0%)、再手术3例(1.2%)、卒中13例(5.0%)、脊髓缺血5例(1.9%)、主动脉破裂12例(4.7%)、逆撕A型夹层4例(1.6%)。平均随访(46.1±35.8)个月,随访期间新增主要不良事件37例(15.4%),其中全因死亡22例(9.2%)、再手术13例(5.4%)、卒中6例(2.5%)、主动脉破裂9例(3.8%)、逆撕A型夹层2例(0.8%)、血管移植物感染3例(1.3%)。术后1年、5年和10年生存率为(90.1±1.9)%、(83.9±2.6)%和(77.1±3.8)%,桥血管通畅率为(98.3±0.8)%、(96.2±1.3)%和(87.9±4.5)%。结论杂交技术是治疗TBAD的有效方法,但近远期并发症发生率较高,需要密切随访。

Objective To investigate the early and long-term outcomes of hybrid technique for type B aortic dissection(TBAD)in a single center.Methods 258 patients with TBAD who underwent hybrid technique in our center from January 2006 to August 2018 were included.There were 238 males(92.2%),with a mean age of(52.4±10.30)years old.Major adverse events were defined as all-cause death,reoperation,stroke,spinal cord ischemia,aortic rupture,retrograde type A dissection and vascular graft infection.Early outcomes were defined as30 days postoperatively or in-hospital events.The long-term survival rate and the patency rate of bypass vessels were evaluated by Kaplan-Meier analysis.Results The success rate of operation was 98.8%(255/258)and the incidence of major adverse events in the early-term was 13.6%(35/258).All-cause death occurred in 18 cases(7.0%),reoperation in 3 cases(1.2%),stroke in 13 cases(5.0%),spinal cord ischemia in 5 cases(1.9%),aortic rupture in 12 cases(4.7%)and retrograde type A dissection in 4 cases(1.6%).The mean follow-up was(46.1±35.8)months and major adverse events were found in 37 cases(15.4%)of the patients during the follow-up.Allcause death occurred in 22 cases(9.2%),reoperation in 13 cases(5.4%),stroke in 6 cases(2.5%),aortic rupture in 9 cases(3.8%),retrograde type A dissection in 2 cases(0.8%)and vascular graft infection in 3 cases(1.3%).The 1-year,5-year and 10-year survival rates were(90.1±1.9)%,(83.9±2.6)%and(77.1±3.8)%,respectively.And the patency rates of bypass at 1-year,5-year and 10-year were(98.3±0.8)%,(96.2±1.3)%and(87.9±4.5)%,respectively.Conclusion Hybrid technique is an effective method for the treatment of TBAD.But the rate of complications is still higher in the early and long-term,which means that close follow-up is needed.