Ⅱ型杂交全主动脉弓修复术治疗不同年龄段Stanford A型主动脉夹层的临床疗效分析

Clinical effects of type Ⅱ hybrid aortic arch repair for type A aortic dissection in elderly and non-elderly patients

目的探讨一期Ⅱ型杂交全主动脉弓修复术治疗不同年龄Stanford A型主动脉夹层患者的有效性。方法回顾性分析2016年1月至2018年12月于阜外医院行杂交全主动脉弓修复术的126例A型主动脉夹层患者的临床资料,其中男78例(61.9%)、女48例(38.1%),平均年龄(61.8±6.9)岁。患者按年龄分为高龄组(≥60岁,n=82)及非高龄组(<60岁,n=44)。对两组患者的术前、术中及术后资料进行分析比较。结果高龄组患者与非高龄组患者年龄差异有统计学意义[(65.9±4.1)岁vs.(54.3±4.1)岁,P<0.010],其它术前基线资料差异无统计学意义。术后早期死亡共6例(4.8%),术后卒中3例(2.4%),截瘫患者2例(1.6%)。共植入支架194枚,平均直径(33.6±1.8)mm,平均长度(199.0±6.7)mm。非高龄组患者呼吸机使用时间[(31.9±41.7)h vs.(61.0±89.2)h,P=0.043]及重症监护室停留时间[(77.8±51.4)h vs.(143.1±114.4)h,P<0.001]均明显短于高龄组。两组患者院内死亡率、再手术率及术后生存率方面差异无统计学意义(P>0.05)。随访1~43(22.6±10.8)个月,3例失访。术后支架段假腔完全血栓化104例(82.5%),内漏11例(9.2%)。结论杂交全主动脉弓修复术治疗Stanford A型主动脉夹层早中期效果满意,非高龄组与高龄组患者早期治疗效果相当,中期随访结果非高龄组优于高龄组。

Objective To discuss the efficacy of type Ⅱ hybrid aortic arch repair for type A aortic dissection in patients of different age groups.Methods We retrospectively analyzed the clinical data of 126 patients with type A aortic dissection admitted to the Fuwai Hospital between January 2016 and December 2018,including 78(61.9%) males and 48(38.1%) females,with an average age of 61.8±6.9 years.The patients were divided into an elderly group(≥ 60 years,n=82)and a non-elderly group(<60 years,n=44).The preoperative,intraoperative and postoperative data of patients in the two groups were compared.Results The age between the elderly and non-elderly group was significantly different(65.9±4.1 years vs.54.3±4.1 years,P<0.010),and no significant difference was found between the two groups in other preoperative baseline data.There were 6(4.8%) patients of early death,3(2.4%) patients of stroke and 2(1.6%) patients of paralysis.A total of 194 stents were implanted,and the average dimeter of the stents was 33.6±1.8 mm and the average length was199.0±6.7 mm.The non-elderly group had shorter mechanical ventilation time(31.9±41.7 h vs.61.0±89.2 h,P=0.043) and ICU stay time(77.8±51.4 h vs.143.1±114.4 h,P<0.001) than the elderly group.There was no significant difference in inhospital mortality rate,reoperation rate or survival rate between the two groups(P>0.05).Follow-up time was 1-43(22.6±10.8) months,and 3 patients were lost.There were 104(82.5%) patients of complete thrombus formation of false lumen in stent and endoleak was reported in 11(9.2%) patients.Conclusion Type Ⅱ hybrid aortic arch repair offers an alternative approach to acute type A aortic dissection with acceptable early and mid-term clinical effects.The non-elderly patients have a similar early treatment effect to the elderly patients,but have a better mid-term outcome.