外科治疗DeBakeyⅠ型和Ⅲ型夹层合并胸腹主动脉瘤的结果对比

Outcomes after Surgical Repair of Thoracoabdominal Aortic Aneurysm with Distal Aortic Dissection:DeBakey TypeⅠversus TypeⅢ

目的对比分析外科治疗DeBakeyⅠ型夹层和Ⅲ型夹层合并胸腹主动脉瘤(TAAA)的早期和中期结果。方法回顾性分析2009年1月至2017年12月在阜外医院接受手术治疗的130例主动脉夹层合并胸腹主动脉瘤患者的临床资料,其中DeBakeyⅠ型患者47例(Ⅰ型组),DeBakeyⅢ型患者83例(Ⅲ型组),比较两组患者手术后的早期结果、中期生存和再干预情况。结果术后30 d,全组死亡9例(6.9%),其中Ⅰ型组5例(10.6%),Ⅲ型组4例(4.8%),差异无统计学意义(χ^2=0.803,P=0.370)。Ⅰ型组和Ⅲ型组术后早期主要不良事件发生率(38.3%比51.8%;χ^2=2.199,P=0.138)、5年生存率[(81.7±5.9)%比(87.2±4.2)%;χ^2=0.483,P=0.487]和5年免于再干预结果[(84.5±6.7)%比(85.5±4.8)%;χ^2=0.010,P=0.920]差异均无统计学意义。结论本组外科治疗DeBakeyⅠ型和Ⅲ型夹层合并TAAA的早期和中期结果相似,今后需进一步扩大样本量进行研究。

Objective To evaluate the early and mid-term results after surgical repair of thoracoabdominal aortic aneurysm(TAAA)in patients with DeBakey typeⅠorⅢaortic dissection.Methods The clinical data of 130 patients who underwent TAAA repair for chronic DeBakey typeⅠ(groupⅠ,n=47)or typeⅢ(groupⅢ,n=83)aortic dissections in our center between January 2009 and December 2017 were retrospectively analyzed.Early postoperative results,midterm survival,and re-interventions were compared between these two groups.Results The 30-day mortality rate was 6.9%(n=9)in the overall cohort,with no statistic difference between groupⅠand groupⅢ(10.6%vs.4.8%;χ^2=0.803,P=0.370).The incidence of major adverse events(38.3%vs.51.8%;χ^2=2.199,P=0.138),5-year actuarial survival rate[(81.7±5.9)%vs.(87.2±4.2)%;χ^2=0.483,P=0.487],and 5-year actuarial freedom from all reinterventions[(84.5±6.7)%vs.(85.5±4.8)%;χ^2=0.010,P=0.920]showed no significant differences between these two groups.Conclusions The early and mid-term outcomes after surgical repair of TAAA are similar for DeBakey typeⅠand typeⅢpatients.However,studies with larger sample sizes are still required.