CAJ | 학술논문

目的总结主动脉腔内修复术(TEVAR)治疗慢性B型主动脉夹层的临床经验.方法 2001年6月至2007年9月,84例慢性B型主动脉夹层病人接受了 TEVAR.从起病至实施TEVAR为1～120个月,平均(13.9±22.0)个月.随访6～86个月,平均(33.2±19.2)个月.结果腔内修复术中,破口被完全封闭77例,内漏发生率为8.3%.1个月的病死率为1.2%.1例在术后1个月发生逆行A型主动脉夹层,行急诊升主动脉和主动脉弓置换术.4例实施了第2次TEVAR,其中3例为封堵内漏,另1例是覆膜支架远端出现新的内膜撕裂.7例在随访期内死亡(8.4%),其中3例死于内漏引起的胸主动脉破裂,1例腹主动脉持续性扩张导致降主动脉破裂死亡,另2例死因与主动脉夹层无关,还有1例死因不详.K-M生存曲线分析显示7年生存率为84.4%.结论早期和中期随访结果显示,TEVAR治疗慢性B型主动脉夹层是有效的.内漏是随访期的主要死因.随着外科医师经验的积累以及覆膜支架的改进,TEVAR会有更好的疗效.
목적 총결주동맥강내수복술(TEVAR)치료만성B형주동맥협층적림상경험.방법 2001년6월지2007년9월,84례만성B형주동맥협층병인접수료 TEVAR.종기병지실시TEVAR위1～120개월,평균(13.9±22.0)개월.수방6～86개월,평균(33.2±19.2)개월.결과 강내수복술중,파구피완전봉폐77례,내루발생솔위8.3%.1개월적병사솔위1.2%.1례재술후1개월발생역행A형주동맥협층,행급진승주동맥화주동맥궁치환술.4례실시료제2차TEVAR,기중3례위봉도내루,령1례시복막지가원단출현신적내막시렬.7례재수방기내사망(8.4%),기중3례사우내루인기적흉주동맥파렬,1례복주동맥지속성확장도치강주동맥파렬사망,령2례사인여주동맥협층무관,환유1례사인불상.K-M생존곡선분석현시7년생존솔위84.4%.결론 조기화중기수방결과현시,TEVAR치료만성B형주동맥협층시유효적.내루시수방기적주요사인.수착외과의사경험적적루이급복막지가적개진,TEVAR회유경호적료효.
Objective The optimal treatment for chronic type B dissection remains controversial. The purpose of this study was to report early and mid-term results of thoracic endovascular aortic repair (TEVAR) of chronic type B aortic dissection. Methods Methods From June 2001 to September 2007, 84 patients with chronic type B aortic dissection received TEVAR. The time between onset of dissection and TEVAR was (13.9 ± 22.0) months (ranged 1 - 120 months). All patients were followed for 6 - 86 months [mean (33.2 ± 19.2) months]. Results The entry tear was completely sealed in 77 cases ( 91.7% ) during TEVAR. The incidence of incomplete seal was 8.3%. One-month mortality was 1. 2%. One patient had retrograde type A dissection 1 month after operation. Four patients received a second TEVAR during follow-up :3 for endoleaking and 1 for newly formed intima tear. Seven patients (8.3%) died during follow-up: 3 thoracic aorta rupture due to endoleaking, 1 abdominal aorta rupture caused by continuous dilation of the abdominal aorta, unrelated to aortic dissection deaths in 2 and 1 died of unknown cause. The Kaplan Meier actuarial survival curve showed a 7-year survival rate of 84.4%. Conclusion Early and mid-term results showed that TEVAR was effective in treating chronic type B aortic dissection. Endoleak was the main cause of death during follow-up. With increasing of physician's experience and refinement of the stent-graft, results are likely to improve in the future.