不同类型主动脉夹层行胸主动脉腔内修复术治疗的疗效及安全性

Efficacy and safety of thoracic aortic endovascular repair for different types of aortic dissection

目的探讨胸主动脉腔内修复术(TEVAR)在复杂型与非复杂型B型主动脉夹层(TBAD)中的治疗效果。方法收集2020年1月至2021年1月解放军联勤保障部队第九六〇医院收治的84例TBAD患者,按照不同分型将其分为复杂组(n=24)与非复杂组(n=60)。比较两组患者的支架使用情况、动脉真腔短径变化情况、假腔血栓化程度、围手术期并发症发生情况、随访期二次手术情况。结果复杂组患者完全遮挡左锁骨下动脉比例明显高于非复杂组患者,差异有统计学意义(P<0.01)。两组患者采用烟囱技术、转流手术比例及使用支架数量比较,差异均无统计学意义(P>0.05)。两组患者4个平面上的动脉真腔短径变化值比较,差异均无统计学意义(P>0.05)。复杂组患者T1节段假腔完全血栓化比例低于非复杂组患者,差异有统计学意义(P<0.05);两组患者T2、T3节段的假腔血栓化程度比较,差异均无统计学意义(P>0.05)。术后,两组患者各并发症发生率、二次手术率比较,差异均无统计学意义(P>0.05)。结论TEVAR治疗复杂型与非复杂型TBAD均能获得较好的动脉重塑效果,二者的近中期生存率相似,TEVAR是治疗复杂型与非复杂型TBAD的理想手段。

Objective To investigate the effect of thoracic endovascular aortic repair(TEVAR)in the treatment of complex and non-complex type B aortic dissection(TBAD).Method A total of 84 TBAD patients treated with TEVAR in the 960th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force from January 2020 to January 2021 were selected and divided into complex group(n=24)and non-complex group(n=60).The use of stents,the change of the short diameter of the true artery lumen,the degree of thrombosis in the false lumen,the occurrence of perioperative complications and the second operation in the follow-up period were compared between the two groups.Result The proportion of completely occluding the left subclavian artery in the complex group was significantly higher than that in the non-complex group,the difference was statistically significant(P<0.01).There were no significant differences between the two groups in terms of chimney technology,the percentage of bypass surgery and the number of stents used(P>0.05).There were no significant differences for the changes of true lumen diameter in complex group and non-complex group on four planes(P>0.05).The proportion of thrombosis in complex group at T1 segment was lower than that in the non-complex group(P<0.05);there was no significant difference between the two groups in the degree of false lumen thrombosis at T2 and T3 segments(P>0.05).There were no significant differences between the two groups for the incidence of complications and secondary surgery rate(P>0.05).Conclusion TEVAR can achieve better arterial remodeling effect in the treatment of complex and non-complex TBAD,their short and mid-term survival rates are similar.TEVAR is optimal treatment method for complex and non-complex TBAD.