2018 年第 10 期 第 13 卷

胸主动脉腔内覆膜支架修复术联合外科转流术或“烟囱”支架置入术对Stanford_B型主动脉夹层术后并发症的影响

Effect of endovascular stent graft repair combined with surgical bypass or chimney stent implantation on postoperative complication of Stanford B aortic dissection

作者：周子凡王龙飞董松坡潘旭东刘宁宁许尚栋朱俊明孙立忠

英文作者：

单位：100029首都医科大学附属北京安贞医院心脏外科

英文单位：

关键词：主动脉夹层；支架修复术；外科转流术；“烟囱”支架置入术；术后并发症

英文关键词：

• 摘要：

• 【摘要】目的    探讨胸主动脉腔内覆膜支架修复术联合外科转流术或“烟囱”支架置入术对Stanford B型主动脉夹层（AD）术后并发症的影响。方法    对首都医科大学附属北京安贞医院2015年3月至2017年3月108例接受血管修复手术治疗的胸主动脉腔内Stanford B型AD患者的临床资料进行回顾性分析，将所有患者按照手术方法分为Ⅰ组（65例）和Ⅱ组（43例）。Ⅰ组患者采用胸主动脉腔内覆膜支架修复术联合外科转流术治疗，Ⅱ组患者采用胸主动脉腔内覆膜支架修复术联合“烟囱”支架置入术治疗。比较2组患者术后并发症发生情况。结果    所有患者手术均成功，Ⅰ组患者住院时间明显长于Ⅱ组［（22±6）d比（16±3）d］，差异有统计学意义（P＜0.01）。住院期间，Ⅰ组65例患者中有25例（38.5%）出现术后并发症（4例术后感染、2例脑梗死、2例逆行性A型夹层、13例肾功能异常、4例死亡），Ⅱ组43例患者中有11例（25.6%）出现术后并发症（3例脑梗死、2例肾功能异常、6例Ⅰ型内漏），2组患者住院期间术后并发症发生率比较差异无统计学意义（P=0.17）。108例患者中85例随访1年，随访率78.7%；Ⅰ组51例患者中4例（7.8%）出现术后并发症（2例移植物感染、2例持续存在逆行性A型夹层），Ⅱ组34例患者中11例（32.4%）出现术后并发症（2例脑梗死、6例Ⅰ型内漏、3例血栓形成）。Ⅱ组术后并发症发生率明显高于Ⅰ组，差异有统计学意义（P=0.01）。结论    对于Stanford B型AD患者而言，随访期间胸主动脉腔内覆膜支架修复术联合“烟囱”支架置入术的术后并发症发生率明显高于胸主动脉腔内覆膜支架修复术联合外科转流术。胸主动脉腔内覆膜支架修复术联合外科转流术更适合外科手术风险较低者，而胸主动脉腔内覆膜支架修复术联合“烟囱”支架置入术更适合外科手术风险较高者。

• 【Abstract】Objective    To investigate the effect of intrathoracic aortic stent graft repair combined with surgical bypass or chimney stent implantation on the postoperative complication of Stanford B aortic dissection. Methods    Clinical data of 108 patients with Stanford B aortic dissection admitted to Beijing Anzhen Hospital, Capital Medical University from March 2015 to March 2017 were analyzed retrospectively. Among them, 65 patients(group Ⅰ) were treated with thoracic aorta endovascular stent graft repair combined with surgical bypass; 43 patients（group Ⅱ） were treated with endovascular stent graft repair and chimney stent implantation. Postoperative complications were analyzed. Results    All patients successfully completed the operation; hospital stay time in the group Ⅰ was significantly longer than that in the group Ⅱ［(22±6)d vs (16±3)d］(P＜0.01). During hospitalization, 25 patients(38.5%) had postoperative complications (4 cases of infection, 2 cases of cerebral infarction, 2 cases of retrograde type A dissection, 13 cases of renal dysfunction and 4 deaths) in the group Ⅰ. In the group Ⅱ, 11 patients(25.6%) had postoperative complications (3 cases of cerebral infarction, 2 cases of renal dysfunction, 6 cases of type I endoleak). There was no significant difference of the incidence of in-hospital complications between groups(P=0.17). Eighty-five patients（78.7%, 51 in the group Ⅰ and 34 in the group Ⅱ） were followed up for 1 year. During follow-up, 4 patients(7.8%) in the group Ⅰ had complications (2 cases of graft infection and 2 cases of continuous retrograde type A dissection); 11 patients(32.4%) in the group Ⅱ had complications(2 cases of cerebral infarction, 6 cases of type I endoleak and 3 cases of thrombosis). The incidence of complications in 1 year after operation in the group Ⅱ was significantly higher than that in the group Ⅰ(P=0.01). Conclusion    For patients with Stanford B aortic dissection, thoracic aorta endovascular stent graft repair combined with surgical bypass may has less postoperative complications than endovascular stent graft repair combined with chimney stent implantation; the former strategy is more suitable for lower risk surgery; the latter strategy is more suitable for high risk surgery.