腔内修复与保守治疗 Stanford B 型主动脉夹层的疗效比较

Comparative study of endovascular and conservative treatment in Stanford type B aortic dissection

摘要:

目的??探讨腔内修复与保守治疗 Stanford?B 型主动脉夹层的疗效及治疗策略。方法??选取 2015 年 6 月—2016 年 6 月承德医学院附属医院接受治疗的 72 例 Stanford?B 型主动脉夹层患者为研究对象，开展前瞻 性随机对照研究。患者均无并发症，按入院先后顺序随机划分为腔内治疗组和保守治疗组，每组 36 例，腔内 治疗接受腔内修复治疗，保守治疗组接受保守治疗。比较两组近期治疗效果及并发症发生情况，随访时间转 院当日至 2017 年 12 月，观察中期预后。结果??腔内治疗组中 35 例（97.22%） 、保守治疗组中 27 例（75.00%） 症状缓解出院， 两组比较差异有统计学意义（ P <0.05） ， 保守治疗组症状缓解出院者较腔内治疗组少 ； 两组院 内病死率比较，差异无统计学意义（ P >0.05） ； 随访期间，两组累积生存率及并发症发生率比较，差异无统计 学意义（ P >0.05） ； 腔内治疗组血栓形成率与保守治疗组比较，差异有统计学意义（ P <0.05） ，腔内治疗组高 于保守治疗组 ； 腔内治疗组治疗后假腔最大直径与保守治疗组比较， 差异有统计学意义（ P <0.05） ， 腔内治疗 组小于保守治疗组。结论??腔内治疗的院内近期疗效较保守治疗好 ； 对症状缓解出院患者，两种治疗方法的 中期预后相似。

Abstract:

Objective To investigate the efficacy of endovascular repair and conservative treatment of Stanford type B aortic dissection. Methods A prospective randomized controlled study was carried out in 72 patients with Stanford type B aortic dissection in our hospital from June 2015 to June 2016. All patients were of no complications. Patients were randomly divided into conservative treatment group and endovascular treatment group (n = 36). Patients in conservative treatment received medication for hypertension and pain without any surgical interventions. Patients in endovascular group received endovascular repair of aortic dissection. The short-term and medium-term effect of treatment as well as occurrence of complications were recorded. Results Incidence of symptom relief in endovascular group was increased significantly compared with that in conservative treatment group (97.22% VS 75.00%, P < 0.05). No statistically significant difference in in-hospital mortality or cumulative survival was identified between the two groups (P > 0.05). Thrombosis rate of false lumen was increased while max diameter of false lumen was decreased obviously in endovascular treatment group compared with those in conservative treatment group (P < 0.05). Conclusions Endovascular treatment is superiror to conservative treatment for patients with aortic dissection , especially in aspect of symptom relief.