主动脉腔内修复术治疗DeBakeyⅢ型主动脉夹层患者的效果及预后

Clinical efficacy and prognosis of aortic endovascular aortic repair in patients with DeBakey Ⅲ aortic dissection

目的 探讨主动脉腔内修复术对DeBakeyⅢ型主动脉夹层(AD)的临床疗效与预后。方法 收集2016年1月至2021年1月收治的96例De BakeyⅢ型AD患者的临床资料,所有患者均接受腔内修复术治疗,统计其术中情况(手术时间、术中出血量、支架直径),比较患者术前、术后近端破口水平、膈肌水平最大直径、瘤体最大直径及主动脉计算机断层扫描血管造影(CTA)三维重建假腔容积、假腔长度的变化,观察患者术前、术后血清炎性因子水平[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]和血清相关指标[D-二聚体(D-D)、基质金属蛋白酶9(MMP9)]。术后随访6~12个月,观察患者的预后情况。结果 所有患者一次性完全隔绝率为87.50%,平均手术时间(1.01±0.19)h,平均支架直径(34.75±2.99)mm,平均术中出血量(67.73±6.65)ml。术后D-D、CRP、TNF-α、IL-6、MMP9水平均低于术前,差异均有统计学意义(P<0.05)。并发症发生率为15.63%预后良好率为95.83%。结论 主动脉腔内修复术治疗De BakeyⅢ型AD临床效果较好,能够有效改善患者的血液高凝状态,减轻患者的炎性反应,抑制细胞外基质降解,且预后较好。

Objective To investigate the clinical efficacy and prognosis of endovascular aortic repair for DeBakey Ⅲ aortic dissection(AD). Method The data of 96 patients with DeBakey Ⅲ AD in the Linfen Central Hospital from January 2016 to January 2021 were collected. All patients received endovascular repair treatment. The operation time, intraoperative blood loss, and stent diameter of patients were evaluated. Preoperative and postoperative proximal rupture level, maximum diameter of diaphragm level, maximum diameter of tumor, and changes of pseudo-cavity volume and length in aortic computed tomography angiography(CTA) 3D reconstruction were compared, preoperative and postoperative serum inflammatory factors [C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), interleukin-6(IL-6)] and serum related indicators [D-dimer(D-D), matrix metalloproteinase 9(MMP9)] of patients were observed. The prognosis was observed after 6-12 months of follow-up. Result The complete isolation rate was 87.50%, the mean operation time was(1.01±0.19) h, the mean stent diameter was(34.75±2.99) mm, and the mean intraoperative blood loss was(67.73±6.65) ml. The levels of D-D, CRP,TNF-α, IL-6 and MMP9 were decreased after surgery compared with those before surgery(P<0.05). The complication rate was 15.63% and the good prognosis rate was 95.83%. Conclusion Endovascular aortic repair for DeBakey Ⅲ AD has good clinical efficacy, which can effectively improve patients’ hypercoagulability, alleviate inflammatory response,and inhibit the degradation of extracellular matrix, with ideal prognosis.