CAJ | 학술논문

目的总结限制性裸支架预防腔内隔绝术后支架移植物远端再发夹层的经验.方法回顾性分析第二军医大学附属长海医院血管外科中心1997年4月至2010年3月,采用腔内隔绝术治疗Stanford B型主动脉夹层674例患者的临床资料.按照纳入标准,共465例病例纳入本研究.结果 311例行经典腔内隔绝术,154例行腔内隔绝术+限制性裸支架植入术.共9例发生远端再发夹层.远端再发夹层组术前不匹配率和随访期不匹配率(腔内移植物远端口径/术前腔内移植物远端水平主动脉夹层真腔长径)明显大于正常组.与传统腔内隔绝术相比,限制性裸支架能有效预防远端再发夹层的发生(0％比2.9％,P=0.033),明显减少再次腔内介入治疗的发生率(3.9％比9.3％,P =0.040).在腔内隔绝术后的主动脉重构方面,限制性裸支架能明显扩张降主动脉最窄段和腔内移植物远端附近的真腔口径.结论腔内移植物远端口径和主动脉夹层真腔受压后的口径不匹配是腔内移植物远端再发夹层的主要危险因素.作为传统腔内隔绝术的辅助技术,合理使用限制性裸支架能降低腔内移植物远端再发夹层的发生率.
목적 총결한제성라지가예방강내격절술후지가이식물원단재발협층적경험.방법 회고성분석제이군의대학부속장해의원혈관외과중심1997년4월지2010년3월,채용강내격절술치료Stanford B형주동맥협층674례환자적림상자료.안조납입표준,공465례병례납입본연구.결과 311례행경전강내격절술,154례행강내격절술+한제성라지가식입술.공9례발생원단재발협층.원단재발협층조술전불필배솔화수방기불필배솔(강내이식물원단구경/술전강내이식물원단수평주동맥협층진강장경)명현대우정상조.여전통강내격절술상비,한제성라지가능유효예방원단재발협층적발생(0％비2.9％,P=0.033),명현감소재차강내개입치료적발생솔(3.9％비9.3％,P =0.040).재강내격절술후적주동맥중구방면,한제성라지가능명현확장강주동맥최착단화강내이식물원단부근적진강구경.결론 강내이식물원단구경화주동맥협층진강수압후적구경불필배시강내이식물원단재발협층적주요위험인소.작위전통강내격절술적보조기술,합리사용한제성라지가능강저강내이식물원단재발협층적발생솔.
Objectives To prevent stent graft induced distal re-dissection (SIDR) after endovascular repair for complicated Stanford type B aortic dissection.Methods From April 1997 to March 2010,674 type B aortic dissections patients were treated by TEVAR at our center.The inclusion criteria for this study had two parts:patients were primarily treated by TEVAR; the estimated mismatch rate (ratio of the distal diameter of the stent graft to the long diameter of the true lumen) was greater than 120％.A total of 465 patients were included in this two-arm study.Results A total of 311 patients were treated with standard TEVAR and 154 patients with TEVAR + restrictive bare stent (RBS).The preoperative mismatch rate (counted by the preoperative long diameter of true lumen at the level of intended distal end of the stentgraft) of the SIDR was significantly higher than that of the non-SIDR [(193 ± 55) ％ vs (132 ± 10) ％,P ＜0.05].The follow-up mismatch rate of SIDR was significantly higher than non-SIDR (145 ±35 vs 120 ± 16,P ＜0.05).Compared with the standard TEVAR,TEVAR + RBS was with lower incidence of SIDR (0％ vs 2.9％,P =0.033) and less secondary intervention (3.9％ vs 9.3％,P =0.040).The placement of RBS significantly expanded the true lumen at the level of descending aorta with narrowest true lumen and at the level of distal end of stent-graft.Conclusions The mismatch between the distal diameter of stent-graft and the diameter of the compressed true lumen seems to contribute to the occurrence of SIDR.Restrictive bare stent,as an adjunctive technique to TEVAR,reduces the incidence of SIDR.