天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (6): 649-652.doi: 10.11958/j.issn.0253-9896.2015.06.019

• 应用研究 • 上一篇    下一篇

Stanford B 型主动脉夹层治疗的临床观察

乔帅， 魏民新， 付强   

  1. 天津医科大学总医院心血管外科
  • 收稿日期:2014-10-17 修回日期:2015-01-09 出版日期:2015-06-15 发布日期:2015-06-10
  • 通讯作者: 乔帅 E-mail:qiaoshuai5755@163.com
  • 基金资助:
    天津市科技计划项目 （14ZCZDSY00023）

Clinical observation of Stanford type B aortic dissection treatment

QIAO Shuai, WEI Minxin, FU Qiang   

  1. Department of Cardiovascular Surgery,General Hospital of Tianjin Medical University

  • Received:2014-10-17 Revised:2015-01-09 Published:2015-06-15 Online:2015-06-10
  • Contact: Shuai QIAO E-mail:qiaoshuai5755@163.com

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摘要： 目的 探讨 Stanford B 型主动脉夹层适宜的治疗方案。方法 回顾性分析天津医科大学总医院 2008 年 5月—2013 年 3 月 51 例 Stanford B 型主动脉夹层患者临床资料， 并通过回访评价患者生存及康复情况。依照是否行胸主动脉覆膜支架隔绝术 （TEVAR）， 分为支架组 40 例及保守组 11 例。结果 40 例患者 TEVAR 手术全部成功， 围手术期死亡 2 例（5%）， 随访期间无死亡患者； 11 例保守治疗患者院内死亡 1 例（9.1%）， 随访期间死亡 7 例（63.6%）。K-M 生存曲线分析显示支架组 2 年生存率明显高于保守组。支架组术后主动脉及假腔最大直径呈减小趋势且假腔血栓化。结论 对于 Stanford B 型主动脉夹层患者， TEVAR 治疗成功率高， 促进主动脉真假腔重塑， 相对传统内科保守治疗可以显著提高患者生存率、 近中期效果好。

关键词: 主动脉疾病, 支架, 手术后并发症, Stanford B 型主动脉夹层, 胸主动脉覆膜支架隔绝术

Abstract: Objective To explore the optimal treatment options of Stanford type B aortic dissection. Methods A total of 51 patients with Stanford type B aortic dissection who visited the General Hospital of Tianjin Medical University from May 2008 to March 2013 were analyzed retrospectively. Survival and recovery of patients were evaluated by follow ups. Patients were divided to TEVAR group（40 cases）and conservative group（11 cases）according to the treatment they recieved.Results Operations were successful in all 40 patients. There were two cases of perioperative death（5%） . And none of patients died in TEVAR group during follow-up. One case among 11 patients who received conservative treatment dead in hospital（9.1%）while other 7 cases died during follow-up（63.6%） . Kaplan-Meier survival curve showed that two-year survival rate of TEVAR group was significantly higher than that of conservative group. In TEVAR group, the maximum diameter of the aorta presented a decreasing trend and thrombosis was seen in artificial lumen with time going after operation. Conclusion For patients with Stanford type B aortic dissection, TEVAR presented a high success rate and promoted remodeling of the aortic genuine and aritificial lumen. What’ s more, it can significantly improve patient’ s survival rate and recovery in
short or mid-term period compared with effect of traditional conservative treatment.

Key words: aortic diseases, stents, postoperative complications, Stanford type B aortic dissection, TEVAR