本文選題：胸主動(dòng)脈腔內(nèi)修復(fù)術(shù)　切入點(diǎn)：主動(dòng)脈夾層　出處：《首都醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的:1、收集整理非復(fù)雜B型夾層病人應(yīng)用TEVAR術(shù)治療的相關(guān)信息,分析TEVAR術(shù)在非復(fù)雜B型夾層病人中的療效。2、對比急性期、亞急性期與慢性期非復(fù)雜B型夾層患者應(yīng)用TEVAR治療的治療結(jié)果,探討非復(fù)雜B型夾層腔內(nèi)修復(fù)術(shù)療效與手術(shù)時(shí)機(jī)的關(guān)系。研究方法:在第一部分中,我們搜集我院自2001年5月至2015年4月行TEVAR術(shù)治療的的非復(fù)雜型B型夾層患者基本信息及手術(shù)情況并對其進(jìn)行隨訪,將所得數(shù)據(jù)進(jìn)行分析,嘗試描述TEVAR在非復(fù)雜B型夾層患者中的長期療效。在第二部分中,我們將所得非復(fù)雜B型夾層病人根據(jù)發(fā)病時(shí)間分為3組,一組為發(fā)病14天以內(nèi)的急性期夾層患者,一組為發(fā)病15至28天的亞急性期患者,一組為發(fā)病時(shí)間大于28天的慢性期患者。比較3組患者手術(shù)的嚴(yán)重并發(fā)癥發(fā)生情況,探討非復(fù)雜B型夾層腔內(nèi)修復(fù)術(shù)療效與手術(shù)時(shí)機(jī)的關(guān)系。結(jié)果:在第一部分中,我們通過統(tǒng)計(jì)與隨訪得知共有851位非復(fù)雜型B型夾層患者在我院接受TEVAR治療,圍術(shù)期死亡6例,死亡率率0.7%,1例(0.1%)發(fā)生不完全性癱瘓,2例(0.2%)發(fā)生完全性癱瘓。患者術(shù)后5年、10年、14年生存率分別為96.3%,84.1%,67.6%。避免二次手術(shù)的比率5年、10年分別為95.9%、92.8%。在第二部分中,共有急性期患者452例,亞急性期患者149例,慢性期患者250例。急性期患者中圍術(shù)期死亡5例(1.1%),隨訪期形成逆行性A型夾層4例(0.9%),亞急性期患者中圍術(shù)期死亡0例,隨訪期形成逆行性A型夾層2例(1.3%)。慢性期患者圍術(shù)期死亡1例(0.4%),隨訪期形成逆行性A型夾層2例(0.8%)。急性期、亞急性期、慢性期手術(shù)與圍術(shù)期死亡及術(shù)后形成逆行性A型夾層的P值均大于0.05,無顯著差異。3組隨訪期生存曲線及避免二次手術(shù)率差異不顯著。結(jié)論:1、TEVAR手術(shù)在急性非復(fù)雜B型夾層患者中應(yīng)用得到了較低的死亡率、并發(fā)癥率與較好的遠(yuǎn)期生存率。2、非復(fù)雜B型夾層患者手術(shù)時(shí)機(jī)與圍術(shù)期死亡及逆行性A型夾層的形成間無明顯關(guān)系,并且不影響遠(yuǎn)期生存率與再手術(shù)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.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R654.3

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本文編號(hào)：1597322