胸主动脉腔内修复术（TEVAR）在非复杂B型夹层病人中的长期疗效及手术时机分析

发布时间：2018-03-11 08:13

本文选题：胸主动脉腔内修复术　切入点：主动脉夹层　出处：《首都医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:1、收集整理非复杂B型夹层病人应用TEVAR术治疗的相关信息,分析TEVAR术在非复杂B型夹层病人中的疗效。2、对比急性期、亚急性期与慢性期非复杂B型夹层患者应用TEVAR治疗的治疗结果,探讨非复杂B型夹层腔内修复术疗效与手术时机的关系。研究方法:在第一部分中,我们搜集我院自2001年5月至2015年4月行TEVAR术治疗的的非复杂型B型夹层患者基本信息及手术情况并对其进行随访,将所得数据进行分析,尝试描述TEVAR在非复杂B型夹层患者中的长期疗效。在第二部分中,我们将所得非复杂B型夹层病人根据发病时间分为3组,一组为发病14天以内的急性期夹层患者,一组为发病15至28天的亚急性期患者,一组为发病时间大于28天的慢性期患者。比较3组患者手术的严重并发症发生情况,探讨非复杂B型夹层腔内修复术疗效与手术时机的关系。结果:在第一部分中,我们通过统计与随访得知共有851位非复杂型B型夹层患者在我院接受TEVAR治疗,围术期死亡6例,死亡率率0.7%,1例(0.1%)发生不完全性瘫痪,2例(0.2%)发生完全性瘫痪。患者术后5年、10年、14年生存率分别为96.3%,84.1%,67.6%。避免二次手术的比率5年、10年分别为95.9%、92.8%。在第二部分中,共有急性期患者452例,亚急性期患者149例,慢性期患者250例。急性期患者中围术期死亡5例(1.1%),随访期形成逆行性A型夹层4例(0.9%),亚急性期患者中围术期死亡0例,随访期形成逆行性A型夹层2例(1.3%)。慢性期患者围术期死亡1例(0.4%),随访期形成逆行性A型夹层2例(0.8%)。急性期、亚急性期、慢性期手术与围术期死亡及术后形成逆行性A型夹层的P值均大于0.05,无显著差异。3组随访期生存曲线及避免二次手术率差异不显著。结论:1、TEVAR手术在急性非复杂B型夹层患者中应用得到了较低的死亡率、并发症率与较好的远期生存率。2、非复杂B型夹层患者手术时机与围术期死亡及逆行性A型夹层的形成间无明显关系,并且不影响远期生存率与再手术率。
[Abstract]:Objective: 1. To collect the information about the treatment of non-complex B dissection patients with TEVAR, and analyze the curative effect of TEVAR in non-complex B dissection patients, and compare the acute stage. The results of TEVAR treatment in patients with subacute and chronic noncomplex B dissection were used to investigate the relationship between the effect of endovascular repair of non complex B dissection and the timing of operation. Methods: in the first part, From May 2001 to April 2015, we collected the basic information of non-complex type B dissection patients treated with TEVAR from May 2001 to April 2015. We followed up the patients and analyzed the data. In the second part, we divided the patients with non-complex B dissection into three groups according to the onset time, one group was acute dissection patients within 14 days. One group of patients with subacute stage and one group of chronic patients with onset time of more than 28 days. The incidence of severe complications in three groups of patients was compared. To investigate the relationship between the effect of endovascular repair of non-complex B type dissection and the opportunity of operation. Results: in the first part, we found that a total of 851 cases of non-complex type B dissection were treated with TEVAR, and 6 cases died during perioperative period. The mortality rate was 0.7% and 1 case / 0.1%) incomplete paralysis occurred in 2 cases (0.2%). The survival rate for 5 years, 10 years and 14 years after operation was 96. 3% respectively. The rate of avoiding second operation was 95. 9% 92. 8% respectively. In the second part, there were 452 cases of acute stage patients, and the survival rates were 96. 3%, 10 years, 9. 9% and 92. 8%, respectively. In the second part, there were 452 patients in the acute stage. There were 149 cases of subacute stage and 250 cases of chronic stage. Among them, 5 cases died in perioperative period, 4 cases formed retrograde type A dissection in follow-up period, and 0 cases died in perioperative period in subacute stage. There were 2 cases of retrograde type A dissection in the follow-up period. 1 case died in the perioperative period of chronic stage, and 2 cases formed retrograde type A dissection in the follow-up period. There was no significant difference in survival curve of follow-up period and rate of avoiding secondary operation in group 3. Conclusion: 1: 1 TEVAR operation in acute non-complex B. In patients with type B dissection, the mortality rate is lower. There was no significant relationship between the operative timing and perioperative death and the formation of retrograde type A dissection, and the long-term survival rate and reoperation rate were not affected.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.3

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