Stanford B型主动脉壁间血肿单中心治疗经验
Single-center experience in treatment of Stanford type B aortic intramural hematoma
赵文鹏 1吕凡振 1胡义良 1陈晒 1方华强 1王世知 1周为民1
作者信息
- 1. 南昌大学第二附属医院血管外科,江西南昌 330006
- 折叠
摘要
目的 评估Stanford B型主动脉壁间血肿(intramural hematoma,IMH)的治疗方法与疗效.方法 选取南昌大学第二附属医院2017年8月至2023年5月期间收治的Stanford B型IMH患者368例,分析其临床资料及治疗效果.结果 根据随访过程中血肿转归情况分为吸收组(n=134)和进展组(n=234),单因素分析结果显示,吸收组与进展组在年龄[(60.59±11.14)岁 vs.(61.86±12.05)岁]、血小板计数[206.00(88.07)× 109/L vs.187.00(86.00)×109/L]、门 冬氨酸氨基转移酶[18.60(19.37)U/L vs.19.50(7.80)U/L]、降主动脉最大直径[35(6)mm vs.34(5)mm]以及血肿远端累及6～11区[157(66.81％)vs.66(49.25％)]方面差异具有统计学意义(P＜0.05).多因素Logistic回归分析结果显示,降主动脉最大直径是Stanford B型IMH进展的独立危险因素(OR=0.943,95％CI:0.899～0.990,P=0.017).出院患者平均随访时间(35.1±17.9)个月,失访率6.8％.药物治疗患者出院后5年生存率为77.4％,腔内治疗患者出院后5年生存率为87.6％.结论 单中心经验表明Stanford B型IMH选择腔内治疗安全、有效,对于降主动脉扩张者,应警惕壁间血肿的进展,必要时手术干预.
Abstract
Objective To evaluate the treatment methods and outcomes for Stanford type B intramural hematoma(IMH).Methods A total of 368 patients with Stanford type B IMH admitted to the Second Affiliated Hospital of Nan-chang University from August 2017 to May 2023 were selected for analysis of their clinical data and treatment outcomes.Results Based on the outcomes during follow-up,the patients were divided into the absorption group(n=134)and the progression group(n=234).Univariate analysis showed significant differences between the absorption and progres-sion groups in terms of age[(60.59±1 1.14)years vs(61.86±12.05)years],platelet count[206.00(88.07)×109/L vs 187.00(86.00)× 109/L],aspartate aminotransferase[18.60(19.37)U/L vs 19.50(7.80)U/L],maximum diameter of the descending aorta[35(6)vs 34(5)mm],and distal hematoma involvement of Zone 6-11[157(66.81％)vs 66(49.25％)](P＜0.05).Multivariate Logistic regression analysis indicated that the maximum diameter of the descending aorta was an independent risk factor for the progression of Stanford type B IMH(OR=0.943,95％CI=0.899-0.990,P=0.017).The average follow-up time for discharged patients was(35.1±17.9)months,with a loss to follow-up rate of 6.8％.The 5-year survival rate post-discharge was 77.4％for the patient with medication treatment and 87.6％for the patient with endovascular treatment.Conclusion Single-center experience suggests that endovascular treatment for Stanford type B IMH is safe and effective.For patients with dilation of the descending aorta,vigilance is required for the progression of intramural hematoma,and surgical intervention may be considered when necessary.
关键词
主动脉壁间血肿/胸主动脉腔内修复术/溃疡样突起/穿透性溃疡/壁内血池Key words
Aortic intramural haematoma/Thoracic endovascular aortic repair/Ulcer-like projections/Penetrating ather-osclerotic ulcer/Intramural blood pools引用本文复制引用
基金项目
南昌大学第二附属基院院内资助项目(2023efyA02)
出版年
2024
NETL
NSTL
万方数据