胸主动脉夹层动脉瘤腔内修复术联合药物治疗稳定型B型主动脉夹层
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摘要
目的对比分析胸主动脉腔内修复术(TEVAR)联合药物与单纯药物治疗对稳定型Standford B型主动脉夹层患者疗效及安全性的影响。方法回顾性分析本院2015年5月至2016年7月收治的142例稳定型Standford B型主动脉夹层患者的临床资料,按照不同治疗方式分为治疗组(n=71)与对照组(n=71)。对照组患者单纯给予药物治疗,治疗组患者在对照组患者基础上联合TEVAR进行治疗,对比分析2组患者的治疗效果及安全性。结果治疗组患者院内死亡率为8. 45%,对照组患者院内死亡率为18. 31%,2组比较差异具有统计学意义(P <0. 05)。治疗组患者术后并发症发生率为12. 68%,对照组患者并未出现主要并发症,2组比较差异具有统计学意义(P <0. 05)。治疗组患者出院30 d内病死率为0,对照组患者出院30 d内病死率为8. 45%,2组比较差异具有统计学意义(P <0. 05)。术后随访6个月、1年、2年的生存率,治疗组分别为94. 37%、85. 92%、77. 46%,对照组分别为91. 55%、83. 10%、71. 83%,2组比较差异无统计学意义(χ2=0. 351,P=0. 172)。结论 TEVAR联合药物治疗稳定型Standford B型主动脉夹层具有良好的近、中期疗效,但术后相关并发症发生率较高,影响预后生存率,应严格把握手术适应证,选择良好手术时机,谨慎术中操作。
Objective To compare the effects and safety of thoracic endovascular aortic repair( TEVAR) combined with drug and drug alone in patients with stable type B aortic dissection. Methods The clinical data of 142 patients with stable Standford type B aortic dissection admitted into our hospital from May 2015 to July 2016 were retrospectively analyzed,who were divided into treatment group( n = 71) and control group( n = 71) according to different treatment methods. The patients in the control group were treated with drugs alone. The patients in the treatment group were treated with TEVAR on the basis of the control group. The therapeutic effects and safety between the two groups were compared. Results The in-hospital mortality rate was 8. 45% in the treatment group and 18. 31% in the control group,there was a significant difference in the in-hospital mortality between the two groups( P < 0. 05). The incidence of postoperative complications in the treatment group was 12. 68%. There was no major complications in the control group. There was a significant difference in the incidence of nosocomial complications between the two groups( P < 0. 05). The mortality of the patients in the treatment group was 0 within 30 days after discharge,and that of the control group was 8. 45%,the difference was significant( P < 0. 05). The survival rates of the treatment group after6 months,1 year and 2 years were 94. 37%,85. 92% and 77. 46%,respectively; the control group were 91. 55%,83. 10% and 71. 83%,respectively,the differences were significant( χ2= 0. 351,P = 0. 172). Conclusion TEVAR combined with drug therapy for stable Standford type B aortic dissection has good short-and medium-term results,but the incidence of postoperative complications is high,which affects the prognosis survival rate. Therefore,in the course of clinical treatment,surgical indications should be strictly controlled,good surgical timing should be selected,and intraoperative operation should be carefully performed to reduce the incidence of postoperative complications and improve the prognosis survival rate.
Objective To compare the effects and safety of thoracic endovascular aortic repair( TEVAR) combined with drug and drug alone in patients with stable type B aortic dissection. Methods The clinical data of 142 patients with stable Standford type B aortic dissection admitted into our hospital from May 2015 to July 2016 were retrospectively analyzed,who were divided into treatment group( n = 71) and control group( n = 71) according to different treatment methods. The patients in the control group were treated with drugs alone. The patients in the treatment group were treated with TEVAR on the basis of the control group. The therapeutic effects and safety between the two groups were compared. Results The in-hospital mortality rate was 8. 45% in the treatment group and 18. 31% in the control group,there was a significant difference in the in-hospital mortality between the two groups( P < 0. 05). The incidence of postoperative complications in the treatment group was 12. 68%. There was no major complications in the control group. There was a significant difference in the incidence of nosocomial complications between the two groups( P < 0. 05). The mortality of the patients in the treatment group was 0 within 30 days after discharge,and that of the control group was 8. 45%,the difference was significant( P < 0. 05). The survival rates of the treatment group after6 months,1 year and 2 years were 94. 37%,85. 92% and 77. 46%,respectively; the control group were 91. 55%,83. 10% and 71. 83%,respectively,the differences were significant( χ2= 0. 351,P = 0. 172). Conclusion TEVAR combined with drug therapy for stable Standford type B aortic dissection has good short-and medium-term results,but the incidence of postoperative complications is high,which affects the prognosis survival rate. Therefore,in the course of clinical treatment,surgical indications should be strictly controlled,good surgical timing should be selected,and intraoperative operation should be carefully performed to reduce the incidence of postoperative complications and improve the prognosis survival rate.
引文
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[6]张林枫,李震,王志伟,等.老年Stanford B型主动脉夹层的临床特点及治疗方案选择[J].中华老年多器官疾病杂志,2017,16(10):749-754. doi:10. 11915/j. issn. 16715403. 2017. 10. 175.
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[9]邱景伟,浦奎,贾忠伟,等. Stanford B型胸主动脉夹层腔内隔绝术后再发A型夹层并致急性下壁心肌梗死1例[J].中国循证心血管医学杂志,2016,8(8):1019-1020. doi:10. 3969/j. issn. 1674-4055. 2016. 08. 41.
[10]陈丽,王雅,王效增,等. Stanford B型主动脉夹层腔内修复术后覆膜支架远端再发夹层临床诊治分析[J].中国实用内科杂志,2017,28(1):63-68. doi:10. 19538/j. nk2017010115.
[11]孟庆友,黄浩岳,余云生,等.覆膜支架腔内修复术治疗Stanford B型主动脉夹层动脉瘤临床研究[J].河北医学,2016,22(12):1945-1948. doi:10. 3969/j. issn. 1006-6233. 2016. 12. 004.
[12]赵龙,刘志平,王坚,等.腔内隔绝术治疗Stanford B型主动脉夹层的临床价值[J].中国循证心血管医学杂志,2016,8(12):1480-1482. doi:10. 3969/j. issn. 1674-4055. 2016. 12. 19.
[13]洪翔,史振宇,符伟国,等. Stanford B型慢性主动脉夹层腔内修复术后血管重塑及其相关因素分析[J].中华普通外科杂志,2016,31(8):628-631. doi:10. 3760/cma. j. issn. 1007-631X.2016. 08. 005.
[14]Lindsay ME,Schepers D,Bolar NA,et al. Loss-of-function mutations in TGFB2 cause a syndromic presentation of thoracic aortic aneurysm[J]. Nat Genet,2012,44(8):922-927. doi:10. 1038/ng. 2349.
[15]张薇,王利新,符伟国.慢性B型主动脉夹层的腔内治疗进展[J].浙江医学,2017,39(19):1718-1721. doi:10. 12056/j.issn. 1006-2785. 2017. 39. 19. 2017-1316.
[16]刘辉,胡亚立,卢辉俊.腔内隔绝术对Stanford B型主动脉夹层患者近中期的疗效分析[J].实用临床医药杂志,2017,21(19):129-131. doi:10. 7619/jcmp. 201719040.
[17]李晓飞,严中亚,卢中,等.单纯腔内隔绝术治疗累及弓部的StanfordB型主动脉夹层疗效观察[J].山东医药,2016,56(6):58-60. doi:10. 3969/j. issn. 1002-266X. 2016. 06. 021.
[18]徐江,胡何节,王晓天,等.亚急性期Standford B型主动脉夹层远端破口特点及其对腔内修复术患者主动脉重塑的影响[J].山东医药,2018,37(22):72-74. doi:10. 3969/j. issn. 1002-266X.2018. 22. 011.
[19]何瑞霞,王雅,王效增,等.腔内修复术治疗复杂型Stanford B型急性主动脉夹层疗效分析[J].临床军医杂志,2017,45(6):593-596. doi:10. 16680/j. 1671-3826. 2017. 06. 10.
[20]陈浩,刘伟,王宏宇,等.复杂型Stanford B型主动脉夹层腔内修复术中左锁骨下动脉重建方式分析[J].现代生物医学进展,2017,17(2):102-107. doi:10. 13241/j. cnki. pmb. 2017. 02. 031.
[21]朱水波,朱健,郗二平,等.胸主动脉腔内修复术治疗复杂性胸主动脉夹层的临床疗效[J].中国循环杂志,2016,31(8):789-792. doi:10. 3969/j. issn. 1000-3614. 2016. 08. 015.
[22]韩磊,万珊杉,王家平,等.不同期Stanford B型胸主动脉夹层腔内修复术后疗效及主动脉重塑临床研究[J].介入放射学杂志,2016,25(11):958-961. doi:10. 3969/j. issn. 1008-794X. 2016. 11. 006.
[23]宋松林,熊斌,郑传胜,等.评估Perclose Proglide血管缝合器在胸主动脉夹层腔内修复术中的应用[J].中国介入影像与治疗学,2017,14(7):396-399. doi:10. 13929/j. 1672-8475. 201703008.
[24]张涛,王峰,纪东华,等.经皮主动脉腔内修复术初步经验[J].介入放射学杂志,2016,25(8):664-667. doi:10. 3969/j.issn. 1008-794X. 2016. 08. 004.
[2]王江云,陈勇,李彦豪,等.腔内修复或药物治疗稳定型B型主动脉夹层[J].介入放射学杂志,2017,26(3):266-269. doi:10. 3969/j. issn. 1008-794X. 2017. 03. 018.
[3]郑一,杨瑞,刘继伟.主动脉夹层覆膜支架腔内修复术后食管破裂并夹层假腔瘘1例[J].中国介入影像与治疗学,2016,13(4):203. doi:10. 13929/j. 1672-8475. 2016. 04. 003.
[4]顾伟,郑博,王令彪,等.主动脉夹层动脉瘤猝死16例尸检临床病理分析[J].解放军医药杂志,2015,40(3):72-74. doi:10.3969/j. issn. 2095-140X. 2015. 03. 018.
[5]王端,罗宇东,范海伦,等. Stanford B型主动脉夹层的诊断治疗[J].国际外科学杂志,2016,43(12):102-107. doi:10. 3760/cma. j. issn. 1673-4203. 2016. 12. 018.
[6]张林枫,李震,王志伟,等.老年Stanford B型主动脉夹层的临床特点及治疗方案选择[J].中华老年多器官疾病杂志,2017,16(10):749-754. doi:10. 11915/j. issn. 16715403. 2017. 10. 175.
[7]Elefteriades JA,Farkas EA. Thoracic aortic aneurysm clinically pertinent controversies and uncertainties[J]. JACC,2010,55(9):841-857. doi:10. 1016/j. jacc. 2009. 08. 084.
[8]王端,罗宇东,范海伦,等. Stanford B型主动脉夹层的诊断治疗[J].国际外科学杂志,2016,43(12):36-41. doi:10. 3760/cma.j. issn. 1673-4203. 2016. 12. 018.
[9]邱景伟,浦奎,贾忠伟,等. Stanford B型胸主动脉夹层腔内隔绝术后再发A型夹层并致急性下壁心肌梗死1例[J].中国循证心血管医学杂志,2016,8(8):1019-1020. doi:10. 3969/j. issn. 1674-4055. 2016. 08. 41.
[10]陈丽,王雅,王效增,等. Stanford B型主动脉夹层腔内修复术后覆膜支架远端再发夹层临床诊治分析[J].中国实用内科杂志,2017,28(1):63-68. doi:10. 19538/j. nk2017010115.
[11]孟庆友,黄浩岳,余云生,等.覆膜支架腔内修复术治疗Stanford B型主动脉夹层动脉瘤临床研究[J].河北医学,2016,22(12):1945-1948. doi:10. 3969/j. issn. 1006-6233. 2016. 12. 004.
[12]赵龙,刘志平,王坚,等.腔内隔绝术治疗Stanford B型主动脉夹层的临床价值[J].中国循证心血管医学杂志,2016,8(12):1480-1482. doi:10. 3969/j. issn. 1674-4055. 2016. 12. 19.
[13]洪翔,史振宇,符伟国,等. Stanford B型慢性主动脉夹层腔内修复术后血管重塑及其相关因素分析[J].中华普通外科杂志,2016,31(8):628-631. doi:10. 3760/cma. j. issn. 1007-631X.2016. 08. 005.
[14]Lindsay ME,Schepers D,Bolar NA,et al. Loss-of-function mutations in TGFB2 cause a syndromic presentation of thoracic aortic aneurysm[J]. Nat Genet,2012,44(8):922-927. doi:10. 1038/ng. 2349.
[15]张薇,王利新,符伟国.慢性B型主动脉夹层的腔内治疗进展[J].浙江医学,2017,39(19):1718-1721. doi:10. 12056/j.issn. 1006-2785. 2017. 39. 19. 2017-1316.
[16]刘辉,胡亚立,卢辉俊.腔内隔绝术对Stanford B型主动脉夹层患者近中期的疗效分析[J].实用临床医药杂志,2017,21(19):129-131. doi:10. 7619/jcmp. 201719040.
[17]李晓飞,严中亚,卢中,等.单纯腔内隔绝术治疗累及弓部的StanfordB型主动脉夹层疗效观察[J].山东医药,2016,56(6):58-60. doi:10. 3969/j. issn. 1002-266X. 2016. 06. 021.
[18]徐江,胡何节,王晓天,等.亚急性期Standford B型主动脉夹层远端破口特点及其对腔内修复术患者主动脉重塑的影响[J].山东医药,2018,37(22):72-74. doi:10. 3969/j. issn. 1002-266X.2018. 22. 011.
[19]何瑞霞,王雅,王效增,等.腔内修复术治疗复杂型Stanford B型急性主动脉夹层疗效分析[J].临床军医杂志,2017,45(6):593-596. doi:10. 16680/j. 1671-3826. 2017. 06. 10.
[20]陈浩,刘伟,王宏宇,等.复杂型Stanford B型主动脉夹层腔内修复术中左锁骨下动脉重建方式分析[J].现代生物医学进展,2017,17(2):102-107. doi:10. 13241/j. cnki. pmb. 2017. 02. 031.
[21]朱水波,朱健,郗二平,等.胸主动脉腔内修复术治疗复杂性胸主动脉夹层的临床疗效[J].中国循环杂志,2016,31(8):789-792. doi:10. 3969/j. issn. 1000-3614. 2016. 08. 015.
[22]韩磊,万珊杉,王家平,等.不同期Stanford B型胸主动脉夹层腔内修复术后疗效及主动脉重塑临床研究[J].介入放射学杂志,2016,25(11):958-961. doi:10. 3969/j. issn. 1008-794X. 2016. 11. 006.
[23]宋松林,熊斌,郑传胜,等.评估Perclose Proglide血管缝合器在胸主动脉夹层腔内修复术中的应用[J].中国介入影像与治疗学,2017,14(7):396-399. doi:10. 13929/j. 1672-8475. 201703008.
[24]张涛,王峰,纪东华,等.经皮主动脉腔内修复术初步经验[J].介入放射学杂志,2016,25(8):664-667. doi:10. 3969/j.issn. 1008-794X. 2016. 08. 004.