急性和慢性B型主动脉夹层介入疗效的对比研究

目的 比较急慢性期主动脉夹层行腔内隔绝术的临床疗效.方法 分析B型主动脉夹层住院患者的临床和影像资料,经股动脉置入覆膜支架封堵胸主动脉破裂口的临床特点、近期及远期疗效.结果 与慢性主动脉夹层组(慢性组)40例相比,急性主动脉夹层组(急性组)42例胸腔积液(16.7%比0,P=0.01),肢体或内脏缺血(23.8%比2.5%,P=0.01)发生率较高.与慢性组相比,急性组近期并发症发生率较高(38.1%比15.0%,P=0.02),出院后对患者进行了(18.7±17.3)个月随访,急性组远期并发症较慢性组发生率较高(21.4%比5.0%,P=0.03).Kaplan-Meier曲线提示两组长期生存率差异无统计学意义(P=0.38),急性组和慢性组5年生存率分别为90.0%、92.5%.慢性组长期无事件生存率显著高于急性组(P=0.04).结论 腔内隔绝术治疗B型主动脉夹层安全有效,但急性组较慢性组并发症增多.

Percutaneous transluminal stenting in patients with acute and chronic aortic dissections

OBJECTIVE: To compare the clinical therapeutic results of percutaneous transluminal stenting between patients with acute and chronic aortic dissections. METHODS: From May 2002 to October 2007, 42 patients with acute type B aortic dissection and 40 patients with chronic aortic dissection underwent stenting. The clinical data of the patients were analyzed. RESULTS: Comparing with the chronic aortic dissection group, the acute aortic dissection group had higher percentage of pleural effusion (16.7% vs 0, P =0.01) and visceral/leg ischemia (23.8% vs 2.5%, P = 0.01). The acute aortic dissection group had higher complications in early term (38.1% vs 15.0%, P = 0.02). All patients were followed up for an average of (18.7 +/- 17.3) months. The rate of complications were higher in the patients with acute aortic dissection than those with chronic aortic dissection (21.4% vs 5.0%, P = 0.03). Kaplan-Meier analysis showed no difference of survival rate between the 2 groups during follow-up period (P = 0.38). The 5-year survival rate was 90.0% in acute aortic dissection group years and 92.5% in chronic aortic dissection group, respectively. The event-free survival rate was higher in the patients with chronic dissection than that with in the patients acute aortic dissection (P = 0.04). CONCLUSIONS: Percutaneous transluminal stenting is effective in the treatment of type B aortic dissection, but there are more complications in acute than in chronic aortic dissection group.