外科治疗主动脉夹层合并胸腹主动脉瘤的长期随访结果

Long-term results after thoracoabdominal aortic aneurysm repair in patients with aortic dissection

目的分析主动脉夹层患者接受胸腹主动脉替换术的长期结果及影响因素。方法收集中国医学科学院阜外医院2009年1月至2017年12月共110例主动脉夹层患者实施胸腹主动脉替换术的临床资料和随访资料,采用Kaplan-Meier方法分析进行生存分析和免于再干预分析,采用Cox方法分析远期死亡的危险因素。结果 110例患者中,男77例,女33例,年龄(39.5±10.3)岁;DeBakeyⅠ型夹层46例(41.8%),Ⅲ型64例(58.2%);CrawfordⅡ型99例(90%),CrawfordⅢ型11例(10%)。术后30 d死亡7例(6.4%),截瘫5例(4.5%)。全部患者完成随访,随访42(15~72)个月。随访期间远期死亡9例(8.2%),术后1年、5年估计生存率分别为90.9%±2.7%和86.8%±3.5%。多因素Cox分析死亡危险因素为年龄(β=0.062,Wald=5.254,P=0.022,OR=1.064,95%CI:1.009~1.122),主动脉直径(β=0.283,Wald=6.331,P=0.012,OR=1.328,95%CI:1.065~1.655),截瘫(β=1.803,Wald=4.166,P=0.041,OR=6.069,95%CI:1.074~34.289)。免于再干预:1年93.9%±2.4%,5年83.6%±4.4%。结论开放手术治疗主动脉夹层合并胸腹主动脉瘤能够取得较好的远期生存,再干预率较低。年龄,主动脉直径,术后截瘫是术后远期死亡的独立危险因素。

Objectives To evaluate the long-term results and relative risk factors of thoracoabdominal aortic aneurysm(TAAA)repair in patients with aortic dissection(AD). Methods Clinical and follow-up data of 110 patients with AD performed TAAA repairs between January 2009 and December 2017 in Fuwai Hospital were analyzed. Survival and freedom from reintervention were calculated using the Kaplan-Meier method,and the risk factors of late death were evaluated using Cox analysis. Results There were 77 male patients and 33 female patients with a mean age of(39.5±10.3)years. Prior DeBakey type Ⅰ AD occurred in 46(41.8%)patients,prior type Ⅲ AD occurred in 64(58.2%)patients. The degree of repair was Crawford extent Ⅱ in 99(90%)patients,and Crawford extent Ⅲ in 11(10%)patients. There were 7(6.4%)early deaths. Permanent paraplegia developed in 5(4.5%)patients. All the patients were followed up,and the median follow-up duration was 42(15-72)months. There were 9(8.2%)late deaths. The actuarial survivals rate was 90.9%±2.7% and 86.8%±3.5% at 1 and 5 years,respectively. Multivariate risk factors for late death were age(β =0.062,Wald=5.254,P=0.022,OR=1.064,95%CI:1.009-1.122),maximal aortic diameter(β =0.283,Wald=6.331,P=0.012,OR=1.328,95%CI:1.065-1.655),paraplegia(β =1.803,Wald=4.166,P=0.041,OR=6.069,95%CI:1.074-34.289). Freedom from reintervention was 93.9%±2.4% and 83.6%±4.4% at 1 and 5 years,respectively.Conclusions Open repair of thoracoabdominal aortic aneurysm in survivors of aortic dissection could have good longterm survival and low rate of reintervention. Age,maximal aortic diameter and paraplegia were the independent predictors of late death.