目的 研究对比胸主动脉腔内修复术(intrathoracic aortic repair，TEVAR)治疗急性主动脉穿透性溃疡(pene-trating aortic ulcer，PAU)合并壁内血肿(intramural hematoma，IMH)、急性 Stanford B 型主动脉夹层(Stanford type B aortic dissection，ATBAD)的临床效果。方法 选择2021年1月-2021年12月河南省胸科医院心外科收治的主动脉扩张性疾病且开展TEVAR治疗的患者108例，并将其分成A组(PAU伴IMH)50例和B组(ATBAD)58例。通过倾斜性评分对两组予以匹配(1∶1)，对两组临床资料进行对比，并比较两组影像学与手术特征、不良事件发生状况。结果 A组匹配前年龄、C反应蛋白(C-Reactive protein，CRP)、血小板(platelet，PLT)、合并脑血管病史、冠心病及吸烟史占比均高于B组，入院血压、白细胞计数(white blood cell count，WBC)和体质量指数(body mass index，BMI)均低于B组，差异存在统计学意义(P＜0。05);匹配前后，两组影像学和手术特征对比，差异无统计学意义(P＞0。05);匹配前后两组住院时间、不良事件比较，差异无统计学意义(P＞0。05);平均随访36个月，A组获得随访率为92。00％(46/50)，B组为94。83％(55/58);匹配前B组全因死亡率及主动脉源性死亡率低于A组，差异存在统计学意义(P＜0。05);但匹配后相比，差异无统计学意义(P＞0。05)。结论 TEVAR治疗急性PAU并IMU安全有效，但相较于ATBAD患者开展TEVAR治疗，其远期预后仍不理想，应重视这类患者的长期随访和管理。
Clinical study of intrathoracic aortic repair for acute penetrating aortic ulcer with intramural hematoma and acute Stanford type B aortic dissection
Objective To compare the clinical effects of intrathoracic aortic repair(TEVAR)in the treatment of acute penetrating aortic ulcer(PAU)complicated with intramural hematoma(IMH)and acute Stanford type B aortic dissec-tion(ATBAD).Methods A total of 108 patients with aortic dilatation disease who received TEVAR treatment from the Department of Cardiac Surgery of Henan Chest Hospital from January 2021 to December 2021 were selected for this stud-y,and divided into group A(PAU with IMH)50 cases and group B(ATBAD)58 cases.The two groups were matched by inclination score(1∶1),and the clinical data of the two groups were compared,as well as the imaging and surgical features and the occurrence of adverse events between the two groups.Results Age,CRP,PLT,cerebrovascular histo-ry,coronary heart disease and smoking history in group A were all higher than those in group B,and blood pressure,WBC and BMI on admission were lower than those in group B,with significant differences(P＜0.05).Before and after matching,there was no significant difference in imaging and surgical features between the two groups(P＞0.05).There was no statistical value in length of hospital stay and adverse events between the two groups before and after matching(P＞0.05).The average follow-up time was 36 months.The follow-up rate of group A and group B was 92.00％(46/50)and 94.83％(55/58)respectively.Before matching,the all-cause mortality and aortic mortality in group B were lower than those in group A,and the difference was significant(P＜0.05).However,there was no statistically significant difference between the two groups after matching(P＞0.05).Conclusion TEVAR is safe and effective in the treatment of acute PAU and IMU,but compared with the treatment of ATBAD patients,the long-term prognosis is still not ideal,and attention should be paid to the long-term follow-up and management of these patients.
NETL
NSTL
万方数据
