摘要
目的探究第一裂口(primary entry tear,PET)周向位置的差异对Stanford B型主动脉夹层(type B aortic dissection,TBAD)患者假腔及胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)后长期预后的影响。方法回顾性分析2009年1月至2023年3月在中国人民解放军总医院第一医学中心接受TEVAR的100例TBAD患者资料。基于PET周向位置定义为大弯组(40例)、侧位组(31例)和小弯组(29例),比较三组患者假腔形态特点特征、临床特征和预后结局指标的差异。结果大弯组比小弯组假腔更长(279.66 mm比193.92 mm,P=0.032)、左肾动脉受累比例更高(45.0%比17.2%,P=0.016)。患者术后随访平均随访时间为(77.20±42.99)个月,38例患者出现并发症,其中20例接受再干预;14例患者出现主动脉相关死亡。三组患者术后并发症、在干预率和死亡的比较差异均无统计学意义(P>0.05)。三组患者长期生存率差异无统计学意义(P>0.05),而随访期免于再干预率大弯组显著低于侧位组(P=0.023)。PET位于大弯是随访期再干预的独立危险因素(风险比=5.996,95%置信区间=1.311~27.431,P=0.021)。结论PET位于大弯可能预示患者容易因TEVAR后并发症而进行再干预。应重视PET位于主动脉大弯患者的治疗,减少并发症发生。
Objective To explore the impact of the circumferential position of the primary entry tear(PET)on morphological characteristics and long-term postoperative outcome of Stanford type B aortic dissection(TBAD).Methods The clinical data of 100 patients with TBAD who underwent thoracic endovascular aortic repair(TEVAR)at the First Medical Center of the Chinese PLA General Hospital from January 2009 to March 2023 were analyzed retrospectivel.Patients were divided into outer curvature group(40 cases),bilateral group(31 cases)and inner curvature group(29 cases)based on the position of PET.Comparative analyses were conducted between the three groups of patients regarding false lumen morphology,clinical characteristics and prognostic outcome indicators.Results In comparison to the inner curvature group,the outer curvature group had longer false lumens(279.66mm vs 193.92mm,P=0.032)and more involvement of the left renal arteries(45.0%vs 17.2%,P=0.016).Patients were followed-up for 77.20±42.99 months,complications occurred in 38 patients,of whom 20 underwent reintervention.There were 14 aortic-related deaths.There were no statistically significant differences in postoperative complications,intervention rate and death among the three groups(P>0.05).There was no statistically significant difference in long-term survival rate among the three groups(P>0.05),but the freedom from re-intervention rate during the follow-up period in the outer curvature group was significantly lower than that in the bilateral group(P=0.023).PET at distal convexity was the only independent predictor for reintervention(hazard ratio=5.996,95%CI=1.311-27.431,P=0.021).Conclusion PET location on the outer curvature may indicate further reintervention due to before post-TEVAR complications.Attention should be paid to the treatment of patients with PET located at the outer curvature of the aorta to reduce the occurrence of complications.
作者
王双静
徐泽鑫
任露霞
员鹏飞
王海博
吴明炜
贾贺月
张栩阳
陈端端
熊江
Wang Shuangjing;Xu Zexin;Ren Luxia;Yuan Pengfei;Wang Haibo;Wu Mingwei;Jia Heyue;Zhang Xuyang;Chen Duanduan;Xiong Jiang(Department of Vascular Surgery,The First Medical Center of PLA General Hospital,Beijing 100853,China;School of Life Science,Beijing Institute of Technology,Beijing 100081,China;Department of Emergency Surgery,Peking University People's Hospital,Beijing 100044,China)
出处
《中国血管外科杂志（电子版）》
2024年第2期126-132,共7页
Chinese Journal of Vascular Surgery(Electronic Version)
基金
国家自然科学基金面上项目(81970404,82170498)
北京市自然科学基金项目(Z210012)。
关键词
主动脉夹层
胸主动脉腔内修复术
裂口
再干预
Aortic dissection
Thoracic endovascular aortic repair
Entry tear
Reintervention
