急性Stanford B型主动脉夹层腔内修复治疗时机与预后的关系

目的：探讨急性Stanford B型主动脉夹层（AADB）腔内修复治疗时机与预后的关系。方法回顾性分析接受经皮主动脉腔内修复术（TEVAR）的156例AADB患者的临床资料，分为发病至TEVAR时间≤7 d组（G1组）、发病至TEVAR时间为7～14 d组（G2组）和发病至TEVAR时间＞14 d组（G3组），比较三组术后3个月主动脉修复情况、院内死亡、平均住院时间及住院费用。结果术前三组患者最小真腔直径与最大假腔直径的比值分别为（0.47±0.33）、（0.42±0.18）及（0.47±0.27）（P＞0.05），术后3个月最大真腔直径与最大假腔直径比值分别为（1.76±0.51）、（1.42±0.30）及（1.34±0.34），组间两两比较G1组显著大于G2组和G3组（P＜0.05），G2组与G3组比较差异无统计学意义（P＞0.05）；术后3个月12例达到主动脉完全修复（G1组8例和G2组4例）；院内死亡患者8例，其中5例因脏器缺血致死，2例因近段夹层形成在术中死亡，1例为不明原因猝死；G1组和G2组的平均住院时间显著少于G3组（P＜0.05），与G3组相比，G1组及G2组的住院费用减少了20000元/人。结论 AADB早期进行TEVAR术有利于术后主动脉修复，可以减少住院时间及费用且安全性可以接受。

Investigate on the correlations between the time of thoracic endovascular aortic repair and prognosis in patients with acute Stanford type B aortic dissection

Objective To investigate the correlations between the time of thoracic endovascular aortic repair （TEVAR） and prognosis in patients with type B acute aortic dissection （AADB）. Methods The clinical data of 156 AADB patients with TEVAR was retrospectively analyzed and divided into 3 groups according to the time from onset of symptom to TEVAR：less than seven days was deifned as group 1 （G1, n=87）, seven days to fourteen days group 2 （G2, n=48）;more than fourteen days was group 3 （G3, n=21）. The status of aortic reconstruction at three months TEVAR, in-hospital mortalities, mean hospital expense and length of stay were compared among three groups. Results Before TEVAR, there was no signiifcant differences in the ratio of smallest true lumen diameter and largest false lumen diameter amony the three groups （0.47±0.33, 0.42±0.18, 0.47±0.27, respectively, P〉0.05）. At three months after TEVAR, the ratio of largest true lumen diameter and largest false lumen diameter among the three groups was signiifcantly greater in group 1 （1.76±0.51） than group 2（1.42±0.30） and group 3（1.34±0.34, P 〈 0.05）, when there was no signiifcant difference between the later two groups. Complete aortic reconstruction （8nbsp;from group 1 and 4 from group 2） was achieved in 12 patients at 3 months after TAVAR. Eight patients died during hospitalization, 5 from visceral ischemic, 2 from proximal aortic dissection, one patient from sudden death. Compared with G3, the hospital expense of group 1 and group 2 was cut down about ￥20000. Length of stay was signiifcant greater in group 3 than in group 1 and group 2 （P〈0.05）. Conclusions Early TEVAR for AADB was safe and beneifcial for aortic reconstruct and reducing the hospital expense and length of stay.