Stanford B型主动脉夹层行腔内修复术的最佳手术时机研究

摘要

Objective To explore the optimal operation time of endovascular repair treating Stanford type B aortic dissection.Methods Clinical data of 50 patients with Stanford type B aortic dissection who had endovascular repair in Wuhan Puren Hospital from March 2015 to April 2016 were retrospectively analyzed;they were divided into acute group(＜ 72 h,28 cases),subacute group(72 h-1 week,16 cases) and chronic group (＞ 1 week,6 cases).Operation data,perioperative complications and postoperative aortic remodeling were analyzed.Results The operation success rate in 50 patients was 100.0％.The incidence of major complications in subacute group was significantly lower than that in acute group and chronic group[12.5％ (2/16) vs 32.1％ (9/28),83.3％ (5/6)] (P ＜0.05).The false lumen thrombosis rate and the change value of maximum false lumen diameter in acute group and subacute group were significantly higher and the maximum postoperative false lumen diameter was significantly lower than those in chronic group(P ＜ 0.05).Conclusion Subacute Stanford type B aortic dissection brings optimal operation time of endovascular repair.%目的 探讨Stanford B型主动脉夹层行腔内修复术的最佳手术时机.方法 回顾性分析2015年3月至2016年4月于武汉市普仁医院行腔内修复术的50例Stanford B型主动脉夹层患者临床资料.根据发病时间将患者分为急性组(＜72 h,28例)、亚急性组(72 h～1周,16例)、慢性组(＞1周,6例).统计3组手术结果、围术期情况、随访结果及主动脉重塑情况.结果 50例Stanford B型主动脉夹层患者均行腔内修复术,手术成功率100.0％ (50/50).亚急性组围术期主要并发症发生率明显低于急性组及慢性组[12.5％(2/16)比32.1％(9/28)、83.3％ (5/6)],差异均有统计学意义(均P＜0.05).急性组、亚急性组假腔血栓化率、假腔最大直径变化值均大于慢性组,且术后假腔最大直径小于慢性组,差异均有统计学意义(均P ＜0.05).结论 Stanford B型主动脉夹层行腔内修复术的最佳手术时机为亚急性期,腔内修复疗效最佳,并发症少.