腔内修复术与药物治疗胸降主动脉穿透性溃疡近远期疗效分析

目的 对比评价腔内修复术(EVAR)与药物治疗（MT）对胸降主动脉穿透性溃疡(PAU)的近、远期疗效。方法 观察2006年3月~2014年3月住院的85例PAU患者，根据治疗方式分为EVAR组（47例）和MT组（38例），EVAR组在强化药物治疗基础上行EVAR治疗，MT组单纯行药物强化治疗，随访观察2组间近期、远期的肢体缺血、截瘫、肾功能衰竭、脑卒中、新发主动脉夹层、死亡等不良事件的发生情况。结果 EVAR组患者47例手术均成功，术中无内漏、支架移位、主动脉破裂死亡及脑卒中等发生。首次入院至30 d随访，2组随访率均为100%，2组无截瘫、脑卒中及死亡事件发生。EVAR组肢体缺血、肾功能衰竭的发生率均略低于MT组，但差异均未达到显著性水平（0 vs. 10%，2% vs. 5%）。MT组新发主动脉夹层发生率显著高于EVAR组（16% vs. 0%，P<0.01）。2组远期随访时间、随访率差异无统计学意义〔（34±22）个月 vs.（32±23）个月，87% vs. 82%〕。远期随访2组间均无截瘫发生，MT组肢体缺血、肾功能衰竭的发生率均略高于EVAR组，但差异均未达到显著水平（16% vs. 2%;13% vs. 5%）。EVAR组总的病死率及主动脉破裂病死率均略低于MT组，但2组间差异均未达到显著水平（5% vs. 13%；2% vs. 6%）。结论 与MT相比，EVAR治疗PUA , 可降低近、远期主动脉夹层的发生率。

Short- and long-term efficacy of endovascular repair and medical treatment of penetration aortic ulcer

AIM To evaluate the short- and long-term clinical efficacy of endovascular repair (EVAR) and medical treatment (MT) in penetration aortic ulcer (PAU). METHODS Eighty-five PAU patients diagnosed from March 2006 to March 2014 were divided into EVAR group in which 47 patients received EVAR plus MT and MT group in which 38 patients received MT only. Short- and long-term clinical events including limb ischemia, paraplegia, renal failure, cerebral ischemia, dissection and death were evaluated in both groups. RESULTS In EVAR group, EVAR was successful in all 47 cases, and no endoleaks, stent migration, aortic rupture and cerebral ischemia occurred during operation. During the 30-day in-hospital follow-up, no negative events including paraplegia, cerebral ischemia and death occurred. The rate of limb ischemia and renal failure in EVAR group was lower than in the MT group, but no significant difference was observed between groups, (0 vs. 10%; 2% vs. 5%). However, the rate of dissection in the MT group was significantly higher than in the EVAR group (16% vs. 0, P=0.006). There was no statistical difference in the mean time of long-term follow-up between groups ［(34±22) months vs.(32±23) months; 87% vs. 82］. No paraplegia occurred, but the cumulative events of limb ischemia and renal failure in MT group were higher (16% vs. 2%; 13% vs. 5%). No statistical difference was found in the cumulative mortality and rupture rate between groups; however, these events in EVAR group were lower than those in MT group (5% vs. 13%; 2% vs. 7%). CONCLUSION Compared with MT alone, endovascular repair can decrease cumulative morality and rate of dissection in treatment of penetration aortic ulcer.