影响血管腔内隔绝术治疗Stanford B型主动脉夹层预后的因素分析

目的 探讨影响血管腔内隔绝术治疗Stanford B型主动脉夹层预后的危险因素.方法 2008年1月至2011年9月在我院行覆膜支架血管腔内隔绝治疗的Stanford B型主动脉夹层患者292例,按腔内隔绝术后1周内是否发生并发症分为并发症组（81例）及无并发症组（211例）,术后半年、1年、2年随访,观察患者近、中期全因死亡.结果 292例均获临床成功,院内总死亡率1.7％.并发症组院内死亡率为6.3％,无并发症组院内死亡率为0,两组比较差异有统计学意义（P=0.002）.平均随访23个月,失访4例,随访期内总死亡率为5.6％,并发症组与无并发症死亡率分别为10.3％和3.8％,两组比较差异有统计学意义（P=0.003）.在多变量COX回归模型中,术前升主动脉最大直径（HR=3.651,95％CI 1.304～10.220,P=0.014）和降主动脉最大直径（HR=1.528,95％ CI 1.237～1.886,P=0.001）为患者2年内全因死亡的独立危险因素.结论 血管腔内隔绝术治疗Stanford B型主动脉夹层术后围手术期并发症可能导致患者近中期死亡风险增加.术前升主动脉最大直径及降主动脉直径是Stanford B型主动脉夹层腔内隔绝术后近中期死亡的独立危险因素.

Effects of endovascular placement of stent-grafts on the prognosis of Stanford type B aortic dissection

Objective To investigate the risk factors affecting the prognosis of Stanford type B aortic dissection treated by endovascular placement of stent-grafts.Methods From January 2008 to September 2011,292 patients with Stanford type B aortic dissection treated by endovascular placement of stent-grafts were enrolled in this study.According to postoperative complications within 1 week,the patients were divided into 2 groups,the complication group（n=81） and the non-complication group（n=211）.The mortality of all patients was investigated at different follow-up time points including in-hospital period,six months,1 year and 2 years of post-operation.Results 292 cases were treated successfully,the overall mortality was 1.7％ in hospital,the mortality of complication group was 6.3％,the mortality of non-complication group was 0,there was significant difference between these two groups （P=0.002）.The mean follow-up time was 23 months,4 patients lost their follow-up,the overall mortality was 5.6％ at 2 years follow-up.The mortality of complication group and non-complication group was 10.3％ and 3.8％ respectively.There was significant difference between these two groups（P＜0.05）.In a multivariable COX regression model,the independent predictors of mortality were the ascending aorta diameter （HR =3.651,95％ CI 1.304-10.220,P=0.014） and the descending aorta diameter （HR=1.528,95％ CI 1.237-1.886,P＜0.01） of preoperative in the near and mid-term.Conclusion The postoperative complications within 1 week of Stanford type B aortic dissection treated by endovascular placement of stent-grafts may indicate an increased risk of death in near and mid-term.The ascending aorta diameter and the descending aorta diameter of preoperative are independent risk factor of mortality in near and mid-term.