摘要
目的:评估Stanford B型胸主动脉夹层(Aortic dissection,AD)患者主动脉腔内修复术(Endovascular aortic repair,EVAR)疗效及主动脉管壁重塑情况。方法:连续收集Stanford B型AD行EVAR患者共30例,所有患者均制定统一的随诊复查计划,术后1月、3月、6月、1年定期复查主动脉CT血管造影检查(Computed tomography angiography,CTA),评估主动脉的变化情况及术后并发症情况。结果:本研究30例患者均成功完成EVAR(100%),男21例(70%),女9例(30%),年龄36~68岁,平均(51.48±3.55)岁,其中急性期AD 15例(50%),亚急性期9例(30%),慢性期6例(20%),EVAR术后平均随访时间(17.31±4.28)月,术后1年内1例死于主动脉破裂,2例发生内漏(Ⅰ型1例,Ⅱ型1例)。AD术后主动脉支架段假腔吸收效果最佳,其次为支架远端胸主动脉段,腹主动脉段效果最差,相对于急性期AD、亚急性期AD患者,慢性期AD的假腔吸收效果明显下降(P<0.05)。术后不同分期AD患者主动脉真腔直径较术前增加,假腔较术前缩小,差异有统计学意义;与急性期及亚急性期AD相比,慢性期AD的真腔及假腔直径变化差值更小。急性期和亚急性期EVAR术后主动脉管腔最大直径均较术前缩小,差异有统计学意义(急性期术前为(3.32±0.19)cm,术后为(2.96±0.27)cm,P=0.00,P<0.05;亚急性期术前为(3.03±0.28)cm,术后为(2.88±0.37)cm,P=0.04,P<0.05),但慢性期患者主动脉管腔直径变化无统计学意义(慢性期术前为(4.15±0.53)cm,术后为(4.12±0.55)cm,P=0.95,P>0.05)。结论:EVAR治疗Stanford B型AD具有一定的近中期疗效,促进AD患者术后主动脉壁的重塑,但不同分期的AD患者行EVAR治疗后主动脉壁重塑效果不同,慢性期患者的主动脉重塑效果较差。
Objective:To evaluate the efficacy of endovascular aortal repair(EVAR)and remodeling of aortic wall in patients with Stanford type B thoracic aortic dissection(AD).Methods:A total of 30 patients with Stanford type B AD who underwent EVAR were collected.A unified follow-up plan was made for all patients.CTA of the aorta was reviewed regularly at 1 month,3 months,6 months and 1 year after the operation to evaluate the changes of the aorta and postoperative complications.Results:In this study,30 patients were successfully completed EVAR(100%),21 males(70%),9 females(30%),aged 36~68 years,the average age was(51.48±3.55)years,including AD 15 cases in acute phase(50%),9 cases(30%)in subacute phase,6 cases(20%)in chronic phase.The average follow-up time after EVAR was(17.31±4.28)months.One case died of aortic rupture within one year after operation,and two cases had internal leakage(1 case in typeⅠand 1 case in typeⅡ).After the operation of AD,the aortic stent segment had the best absorption effect,followed by the distal thoracic aorta segment,and the abdominal aorta segment had the worst effect.Compared with AD patients in the acute and subacute phase,the absorption effect of AD patients in chronic phase was significantly decreased(P<0.05).In patients with AD at different stages after surgery,the true lumen diameter of the aorta was larger and the false lumen was smaller than that before surgery,and the difference was statistically significant(P<0.05).Compared with AD in the acute phase and subacute phase,the difference between the true lumen diameter and the false lumen diameter in the chronic phase was smaller.The maximum diameter of the vasculature after EVAR in the acute and subacute phase was smaller than that before EVAR,the difference was statistically significant(before operation in acute phase(3.32±0.19)cm,after operation(2.96±0.27)cm,P=0.00,P<0.05;before operation in subacute phase(3.03±0.28)cm,after operation(2.88±0.37)cm,P=0.04,P<0.05),but the change of the aortic lumen diameter in the chronic phase was not statistically significant(before operation in chronic phase(4.15±0.53)cm,after operation(4.12±0.55)cm,P=0.95,P>0.05).Conclusion:EVAR in the treatment of Stanford type B AD patients has a certain short-term and medium-term effect,promoting the remodeling of the aortic wall after AD surgery,but the effect of EVAR treatment in AD patients with different phases of aortic wall remodeling is different,the effect of aortic remodeling in chronic phase is the worst.
作者
高新华
刘兆玉
GAO Xin-hua;LIU Zhao-yu(Department of Rudiology,Shenjing Hospital of China Medical University,Shenyang 110004,China)
出处
《中国临床医学影像杂志》
CAS
2020年第8期534-537,共4页
Journal of China Clinic Medical Imaging
