急性Stanford B型主动脉夹层患者行TEVAR术介入治疗的疗效研究

目的 探讨急性Stanford B型主动脉夹层(TBAD)患者行胸主动脉腔内修复术(TEVAR)介入治疗的临床效果。 方法 选择2014年1月—2017年9月河南省人民医院收治的112例TBAD患者,均接受TEVAR介入治疗,根据介入治疗时间分为急性组(起病<14 d,65例)和非急性组(起病≥14 d,47例)。比较2组患者发病至TEVAR治疗时间、住院时间、住院费用、术后并发症、假腔内血栓形成情况,观察手术前后主动脉真腔/主动脉直径比(TLi)、假腔/主动脉直径比(FLi)变化情况,随访2年,分析2组患者生存情况。 结果 急性组患者发病至TEVAR治疗时间、住院时间均短于非急性组,住院费用低于非急性组(t=20.686、8.090、3.071,P<0.05),假腔内血栓完全吸收率高于非急性组(χ2=5.993,P<0.05);术后3个月,2组患者TLi较术前升高,FLi较术前降低,且急性组改善幅度高于非急性组(t=5.268、14.098,P<0.05);急性组患者总生存率(92.31%)高于非急性组患者(85.11%),但2组比较差异无统计学意义(Log-rankχ2=1.479,P>0.05)。 结论 急性TBAD患行TEVAR治疗的假腔内血栓完全吸收率较高,术后主动脉重塑效果较好,且能缩短住院时间、减少住院费用,是更佳的治疗时机。 

Efficacy of TEVAR interventional therapy on patients with acute Stanford type B aortic dissection

Objective To investigate the clinical effects of thoracic endovascular aortic repair(TEVAR) interventional therapy on patients with acute Stanford type B aortic dissection(TBAD). Methods A total of 112 TBAD patients admitted to Henan Provincial People' s Hospital from January 2014 to September 2017 were selected. All patients received TEVAR interventional therapy, and they were divided into acute group(disease onset<14 d, 65 cases) and non-acute group(disease onset ≥ 14 d, 47 cases) according to the interventional therapy time. The time from onset to TEVAR treatment, hospital stay, hospitalization cost, postoperative complications and false lumen thrombosis were compared between the two groups. The aortic true lumen/aortic diameter ratio(TLi) and false lumen/aortic diameter ratio(FLi) were observed before and after surgery. Follow-up for 2 years, the survival was analyzed. Results The time from onset to TEVAR treatment and hospital stay in the acute group were shorter than those in the non-acute group, the hospitalization cost was lower than that in the non-acute group(t=20.686, 8.090, 3.071, P<0.05), and the complete absorption rate of false lumen thrombosis was higher than that in the non-acute group(χ2=5.993, P<0.05). Three months after surgery, the TLi in the two groups was increased compared with that before surgery, while the FLi was decreased compared with that before surgery, and the improvement in the acute group was higher than that in the non-acute group(t=5.268, 14.098, P<0.05). The overall survival rate in the acute group was higher than that in the non-acute group(92.31% vs. 85.11%, Log-rank χ2=1.479, P>0.05). Conclusion TEVAR for patients with acute TBAD has high complete absorption rate of false lumen thrombosis and good postoperative aortic remodeling, and it can shorten hospital stay and reduce hospitalization cost, and it is a better treatment timing.