腔内修复与保守治疗Stanford B型主动脉夹层的疗效比较
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摘要
目的探讨腔内修复与保守治疗Stanford B型主动脉夹层的疗效及治疗策略。方法选取2015年6月—2016年6月承德医学院附属医院接受治疗的72例Stanford B型主动脉夹层患者为研究对象,开展前瞻性随机对照研究。患者均无并发症,按入院先后顺序随机划分为腔内治疗组和保守治疗组,每组36例,腔内治疗接受腔内修复治疗,保守治疗组接受保守治疗。比较两组近期治疗效果及并发症发生情况,随访时间转院当日至2017年12月,观察中期预后。结果腔内治疗组中35例(97.22%)、保守治疗组中27例(75.00%)症状缓解出院,两组比较差异有统计学意义(P <0.05),保守治疗组症状缓解出院者较腔内治疗组少;两组院内病死率比较,差异无统计学意义(P>0.05);随访期间,两组累积生存率及并发症发生率比较,差异无统计学意义(P>0.05);腔内治疗组血栓形成率与保守治疗组比较,差异有统计学意义(P <0.05),腔内治疗组高于保守治疗组;腔内治疗组治疗后假腔最大直径与保守治疗组比较,差异有统计学意义(P <0.05),腔内治疗组小于保守治疗组。结论腔内治疗的院内近期疗效较保守治疗好;对症状缓解出院患者,两种治疗方法的中期预后相似。
Objective To investigate the efficacy of endovascular repair and conservative treatment of Stanford type B aortic dissection. Methods A prospective randomized controlled study was carried out in 72 patients with Stanford type B aortic dissection in our hospital from June 2015 to June 2016. All patients were of no complications.Patients were randomly divided into conservative treatment group and endovascular treatment group(n = 36).Patients in conservative treatment received medication for hypertension and pain without any surgical interventions.Patients in endovascular group received endovascular repair of aortic dissection. The short-term and medium-term effect of treatment as well as occurrence of complications were recorded. Results Incidence of symptom relief in endovascular group was increased significantly compared with that in conservative treatment group(97.22% VS 75.00%, P < 0.05). No statistically significant difference in in-hospital mortality or cumulative survival was identified between the two groups(P > 0.05). Thrombosis rate of false lumen was increased while max diameter of false lumen was decreased obviously in endovascular treatment group compared with those in conservative treatment group(P < 0.05). Conclusions Endovascular treatment is superiror to conservative treatment for patients with aortic dissection, especially in aspect of symptom relief.
Objective To investigate the efficacy of endovascular repair and conservative treatment of Stanford type B aortic dissection. Methods A prospective randomized controlled study was carried out in 72 patients with Stanford type B aortic dissection in our hospital from June 2015 to June 2016. All patients were of no complications.Patients were randomly divided into conservative treatment group and endovascular treatment group(n = 36).Patients in conservative treatment received medication for hypertension and pain without any surgical interventions.Patients in endovascular group received endovascular repair of aortic dissection. The short-term and medium-term effect of treatment as well as occurrence of complications were recorded. Results Incidence of symptom relief in endovascular group was increased significantly compared with that in conservative treatment group(97.22% VS 75.00%, P < 0.05). No statistically significant difference in in-hospital mortality or cumulative survival was identified between the two groups(P > 0.05). Thrombosis rate of false lumen was increased while max diameter of false lumen was decreased obviously in endovascular treatment group compared with those in conservative treatment group(P < 0.05). Conclusions Endovascular treatment is superiror to conservative treatment for patients with aortic dissection, especially in aspect of symptom relief.
引文
[1]陈纪言,罗淞元,刘媛.急性主动脉夹层的腔内修复术治疗现状与展望[J].中国循环杂志,2014,29(1):1-3.
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[12]陶然,梁惠民,冯敢生,等.Stanford B型主动脉夹层腔内修复术后血管重塑分析[J].介入放射学杂志,2016,25(3):206-209.
[13]VIRTUE Registry Investigators.Mid-term outcomes and aortic remodelling after thoracic endovascular repair for acute,subacute,and chronic aortic dissection:the VIRTUE Registry[J].Eur J Vasc Endovasc Surg,2014,48(4):363-371.
[14]ROHLFFS F,TSILIMPARIS N,DIENER H,et al.Chronic type B aortic dissection:indications and strategies for treatment[J].JCardiovasc Surg(Torino),2015,56(2):231-238.
[15]GROMMES J,GREINER A,BENDERMACHER B,et al.Risk factors for mortality and failure of conservative treatment after aortic type B dissection[J].J Thorac Cardiovasc Surg,2014,148(5):2155-2160.
[16]WASINRAT J,LERTKOWIT M,SIRIAPISITH T.Growth rate of aortic diameter in post treatment of aortic dissection[J].J Med Assoc Thai,2015,98(9):902-909.
[17]BANNAZADEH M,TADROS R O,MCKINSEY J,et al.Contemporary management of type B aortic dissection in the endovascular era[J].Surg Technol Int,2016,28(4):214-221.
[18]CHEN D,MüLLER-ESCHNER M,KOTELIS D,et al.Alongitudinal study of Type-B aortic dissection and endovascular repair scenarios:computational analyses[J].Med Eng Phys,2013,35(9):1321-1330.
[19]朱岩,刘建民,翟水亭.开放手术与腔内修复术治疗复杂性B型主动脉夹层的远期疗效比较[J].实用医学杂志,2016,32(5):747-750.
[20]MOULAKAKIS K G,MYLONAS S N,DALAINAS I,et al.Management of complicated and uncomplicated acute type B dissection.A systematic review and meta-analysis[J].Ann Cardiothorac Surg,2014,3(3):234-246.
[2]SUEYOSHI E,ONITSUKA H,NAGAAMA H,et al.Endovascular repair of aortic dissection and intramural hematoma:indications and serial changes[J].Springerplus,2014(3):670.
[3]YANG B,PATEL H J,WILLIAMS D M,et al.Management of type:a dissection with malperfusion[J].Ann Cardiothorac Surg,2016,5(4):265-274.
[4]PATEL A Y,EAGLE K A,VAISHNAVA P.Acute type B aortic dissection:insights from the international registry of acute aortic dissection[J].Ann Cardiothorac Surg,2014,3(4):368-374.
[5]陈作观,李拥军.腔内治疗急性与非急性Stanford B型夹层国内文献的Meta分析[J].中华普通外科杂志,2016,31(8):681-685.
[6]黄小勇,黄连军,郭曦,等.“两段式”覆膜支架置入术个性化治疗Stanford B型主动脉夹层的效果[J].中华心血管病杂志,2015,43(1):39-43.
[7]胡锐,王志维,胡小平.Stanford B型主动脉夹层的治疗选择[J].中华普通外科杂志,2014,29(7):538-541.
[8]NIENABER C A,FATTORI R,LUND G,et al.Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement[J].N Engl J Med,1999,340(20):1539-1545.
[9]马祥云,赵根尚.Stanford B型主动脉夹层覆膜支架腔内修复术近中期的疗效[J].实用医学杂志,2017,33(23):3942-3945.
[10]付志明,李潮杰,李志,等.Standford B型主动脉夹层动脉瘤覆膜支架修复术的临床效果分析[J].临床放射学杂志,2015,34(9):1476-1479.
[11]AMELI-RENANI S,DAS R,MORGAN R A.Thoracic endovascular aortic repair for the treatment of aortic dissection:post-operative imaging,complications and secondary interventions[J].Cardiovasc Intervent Radiol,2015,38(6):1391-1404.
[12]陶然,梁惠民,冯敢生,等.Stanford B型主动脉夹层腔内修复术后血管重塑分析[J].介入放射学杂志,2016,25(3):206-209.
[13]VIRTUE Registry Investigators.Mid-term outcomes and aortic remodelling after thoracic endovascular repair for acute,subacute,and chronic aortic dissection:the VIRTUE Registry[J].Eur J Vasc Endovasc Surg,2014,48(4):363-371.
[14]ROHLFFS F,TSILIMPARIS N,DIENER H,et al.Chronic type B aortic dissection:indications and strategies for treatment[J].JCardiovasc Surg(Torino),2015,56(2):231-238.
[15]GROMMES J,GREINER A,BENDERMACHER B,et al.Risk factors for mortality and failure of conservative treatment after aortic type B dissection[J].J Thorac Cardiovasc Surg,2014,148(5):2155-2160.
[16]WASINRAT J,LERTKOWIT M,SIRIAPISITH T.Growth rate of aortic diameter in post treatment of aortic dissection[J].J Med Assoc Thai,2015,98(9):902-909.
[17]BANNAZADEH M,TADROS R O,MCKINSEY J,et al.Contemporary management of type B aortic dissection in the endovascular era[J].Surg Technol Int,2016,28(4):214-221.
[18]CHEN D,MüLLER-ESCHNER M,KOTELIS D,et al.Alongitudinal study of Type-B aortic dissection and endovascular repair scenarios:computational analyses[J].Med Eng Phys,2013,35(9):1321-1330.
[19]朱岩,刘建民,翟水亭.开放手术与腔内修复术治疗复杂性B型主动脉夹层的远期疗效比较[J].实用医学杂志,2016,32(5):747-750.
[20]MOULAKAKIS K G,MYLONAS S N,DALAINAS I,et al.Management of complicated and uncomplicated acute type B dissection.A systematic review and meta-analysis[J].Ann Cardiothorac Surg,2014,3(3):234-246.