胸主动脉腔内修复术联合限制性裸支架治疗B型主动脉夹层对术后主动脉重塑的影响

发布时间：2018-11-29 13:13

【摘要】：目的:探讨胸主动脉腔内修复术(TEVAR)联合限制性裸支架(RBS)治疗胸主动脉夹层对术后主动脉重塑的影响。方法:回顾性分析2012年8月—2014年8月收治的20例B型主动脉夹层患者资料,其中11例行单纯TEVAR术(TEVAR组)与9例行TEVAR联合RBS(TEVAR+RBS组)。根据术前及术后随访期间行主动脉全长CTA数据,比较两组术后主动脉重塑相关指标。结果:两组手术技术成功率均为100%,术后无截瘫、脑卒中、主动脉破裂等并发症发生。TEVAR+RBS组中RBS与覆膜支架平均重叠了36.5 mm。与TEVAR组比较,TEVAR+RBS组术后整体真腔体积扩大率明显降低(34.9%vs.64.9%,P=0.011);支架远端面积扩大率(43.5%vs.107.3%,P=0.006)、支架远端最长径扩大率(-12.2%vs.18.5%,P=0.002)均明显降低;TEVAR组与TEVAR+RBS组术后整体假腔体积缩小率(74.8%vs.65.3%,P=0.328)、假腔内血栓化比率均无统计学差异(47.3%vs.56.8%,P=0.271)。结论:与单纯TEVAR术比较,TEVAR+RBS对胸主动脉夹层术后主动脉重塑整体改善的程度并没有优势,但可有效降低TEVAR术后支架远端真腔面积(或最长径)过度扩大,因而可能降低支架远端再发破口的发生。
[Abstract]:Objective: to investigate the effect of (TEVAR) combined with restricted bare stent (RBS) on aortic remodeling after thoracic aortic dissection. Methods: the data of 20 patients with type B aortic dissection admitted from August 2012 to August 2014 were retrospectively analyzed, of which 11 cases were treated with TEVAR alone (TEVAR group) and 9 cases with TEVAR combined with RBS (TEVAR RBS group. The aortic remodeling parameters were compared between the two groups according to the CTA data of aorta during preoperative and postoperative follow-up. Results: the successful rate of operation was 100% in both groups. No paraplegia, stroke, aortic rupture and other complications occurred in. TEVAR RBS group. The mean overlap between RBS and stent was 36.5 mm.. Compared with TEVAR group, the enlargement rate of whole true cavity volume in, TEVAR RBS group was significantly lower than that in, TEVAR RBS group (34.9vs.64.9). The enlargement rate of distal area (43.5 vs 107.3) and the longest diameter of distal stent (-12.2vs.18.5P0.002) were significantly decreased. There was no significant difference between TEVAR group and TEVAR RBS group in the reduction rate of global pseudo-lumen volume (74.8vs.65.3) and the ratio of intracavitary thrombus (47.3% vs 56.8% P0.271). Conclusion: compared with TEVAR alone, TEVAR RBS has no advantage in the improvement of aortic remodeling after thoracic aortic dissection, but it can effectively reduce the excessive enlargement of the distal true lumen area (or the longest diameter) after TEVAR. It is possible to reduce the occurrence of recurrent breaks in the distal end of the stent.
【作者单位】：中南大学湘雅医院放射科;中南大学湘雅医院血管外科;
【分类号】：R654.3

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