發(fā)布時間：2018-11-29 13:13

【摘要】：目的:探討胸主動脈腔內(nèi)修復(fù)術(shù)(TEVAR)聯(lián)合限制性裸支架(RBS)治療胸主動脈夾層對術(shù)后主動脈重塑的影響。方法:回顧性分析2012年8月—2014年8月收治的20例B型主動脈夾層患者資料,其中11例行單純TEVAR術(shù)(TEVAR組)與9例行TEVAR聯(lián)合RBS(TEVAR+RBS組)。根據(jù)術(shù)前及術(shù)后隨訪期間行主動脈全長CTA數(shù)據(jù),比較兩組術(shù)后主動脈重塑相關(guān)指標(biāo)。結(jié)果:兩組手術(shù)技術(shù)成功率均為100%,術(shù)后無截癱、腦卒中、主動脈破裂等并發(fā)癥發(fā)生。TEVAR+RBS組中RBS與覆膜支架平均重疊了36.5 mm。與TEVAR組比較,TEVAR+RBS組術(shù)后整體真腔體積擴(kuò)大率明顯降低(34.9%vs.64.9%,P=0.011);支架遠(yuǎn)端面積擴(kuò)大率(43.5%vs.107.3%,P=0.006)、支架遠(yuǎn)端最長徑擴(kuò)大率(-12.2%vs.18.5%,P=0.002)均明顯降低;TEVAR組與TEVAR+RBS組術(shù)后整體假腔體積縮小率(74.8%vs.65.3%,P=0.328)、假腔內(nèi)血栓化比率均無統(tǒng)計學(xué)差異(47.3%vs.56.8%,P=0.271)。結(jié)論:與單純TEVAR術(shù)比較,TEVAR+RBS對胸主動脈夾層術(shù)后主動脈重塑整體改善的程度并沒有優(yōu)勢,但可有效降低TEVAR術(shù)后支架遠(yuǎn)端真腔面積(或最長徑)過度擴(kuò)大,因而可能降低支架遠(yuǎn)端再發(fā)破口的發(fā)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.
【作者單位】： 中南大學(xué)湘雅醫(yī)院放射科;中南大學(xué)湘雅醫(yī)院血管外科;
【分類號】：R654.3

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本文編號：2365089