体外开窗腔内修复术治疗Ⅲ型主动脉夹层累及分支血管的效果及远期预后观察

Effect and long-term prognosis of fenestrated thoracic endovascular aneurysm repair on patients with typeⅢaortic dissection involving branch vessels

目的:探究体外开窗腔内修复术(TEVAR)治疗Ⅲ型主动脉夹层累及分支血管的效果及对患者远期预后的影响。方法:抽取2016年10月至2018年5月在南阳医学高等专科学校第一附属医院接受治疗的78例Ⅲ型主动脉夹层累及分支血管患者为研究对象,根据手术方式将患者分为观察组(行体外开窗TEVAR治疗,43例)和对照组(行单纯TEVAR治疗,35例)。比较两组患者的手术时间和围术期情况;术后随访2年,比较两组患者的支架通畅率、内漏发生率、并发症发生情况、手术再干预率及远期生存率。结果:观察组手术时间长于对照组(P<0.05)。两组患者术中支架全部释放成功。围术期,观察组出现1例轻微支架远端内漏,对照组出现2例Ⅰ型内漏。随访2年,观察组失访2例,对照组失访3例。术后6个月,两组患者支架畅通率均为100.00%;观察组并发症发生率(4.88%,2/41)低于对照组(21.88%,7/32),P<0.05;两组患者内漏发生率比较差异未见统计学意义(P>0.05)。观察组随访期间无再次手术者,对照组随访期间有4例再次行TEVAR治疗,观察组再干预率(0.00%,0/41)低于对照组(12.50%,4/32),P<0.05。观察组2年生存率(97.56%,40/41)与对照组(90.63%,29/32)比较差异未见统计学意义(P>0.05)。结论:应用体外开窗TEVAR治疗累及分支血管的Ⅲ型主动脉夹层,可明显减少患者短期并发症,降低术后2年内的手术再干预率,患者远期预后效果良好。

Objective To investigate the clinical effect and the long-term prognosis of fenestrated thoracic endovascular aneurysm repair(TEVAR)in the treatment of typeⅢaortic dissection involving branch vessels.Methods A total of 78 patients with typeⅢaortic dissection involving branch vessels who were treated in the First Affiliated Hospital of Nanyang Medical College from October 2016 to May 2018 were selected as the research objects.The patients were divided into observation group(treated by fenestrated TEVAR,n=43)and control group(treated by TEVAR,n=35)according to the operation methods.The operation time and perioperative conditions of the two groups were compared.All patients were followed up for 2 years.The stent patency rate,endoleak rate,complications,re-intervention rate and long-term survival rate were compared between the two groups.Results The operation time of the observation group was longer than that of the control group(P<0.05).The stents were placed successfully in both groups.There was 1 case of slight distal stent endoleak in the observation group and 2 cases of type I endoleak in the control group during the perioperative period.Both groups were followed up for 2 years,there were 2 cases lost to follow-up in the observation group and 3 cases lost to follow-up in the control group.The stent patency rates of the two groups both were 100.00%,6 months after operation;and the incidence of complications in the observation group(4.88%,2/41)was lower than that in the control group(21.88%,7/32),P<0.05.There was no significant difference in the incidence of endoleak between the two groups(P>0.05).No one required re-intervention in the observation group during follow-up;and 4 patients in the control group underwent TEVAR again;the re-intervention rate of the observation group(0.00%,0/41)was lower than that of the control group(12.50%,4/32),P<0.05.The 2-year survival rate was 97.56%(40/41)in the observation group,and it was 90.63%(29/32)in the control group,while there was no statistically significant difference between the two groups(P>0.05).Conclusions Fenestrated TEVAR,in the treatment of typeⅢaortic dissection involving branch vessels,can significantly reduce the short-term complications and the re-intervention rate within 2 years after surgery.And the long-term prognosis is good.