[1]王丽娟,孙桂芳,刘训强,等.Stanford B型主动脉夹层腔内修复术后早期死亡患者术前多层螺旋CT特征分析[J].介入放射学杂志,2020,29(04):357-361.
　WANG Lijuan,SUN Guifang,LIU Xunqiang,et al.Analysis of preoperative MSCT features in early death patients with Stanford type B aortic dissection after endovascular repair[J].journal interventional radiology,2020,29(04):357-361.
点击复制

Stanford B型主动脉夹层腔内修复术后早期死亡患者术前多层螺旋CT特征分析()

PDF下载中关闭

分享到：

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
29
期数:
2020年04
页码:
357-361
栏目:
血管介入
出版日期:
2020-05-08

文章信息/Info

Title:
Analysis of preoperative MSCT features in early death patients with Stanford type B aortic dissection after endovascular repair
作者:
王丽娟; 孙桂芳; 刘训强; 王家平; 刘慧; 刘斌; 侯凯
Author(s):
WANG Lijuan;  SUN Guifang;  LIU Xunqiang;  WANG Jiaping;  LIU Hui;  LIU Bin;  HOU Kai.
Department of Radiology, Affiliated Yan’an Hospital, Kunming Medical University, Kunming, Yunnan Province 650051, China
关键词:
【关键词】　主动脉夹层; Stanford B型; 腔内修复术; 死亡; 多层螺旋CT
文献标志码:
A
摘要:
【摘要】　目的?探讨术前多层螺旋CT（MSCT）对Stanford B型主动脉夹层血管腔内修复术后早期死亡的预测价值。方法?回顾性分析2014年1月至2018年12月采用腔内修复术治疗的158例急性期和亚急性期Stanford B型主动脉夹层患者临床随访资料和术前MSCT图像。测量和记录破口位置、破口大小、降主动脉最大直径、气管分叉平面主动脉直径、气管分叉平面假腔面积占该平面主动脉管腔总面积百分比、重要分支血管受累情况、假腔状态、腹主动脉是否受累等CT参数。分析术前CT各参数与患者术后30 d死亡的关系。结果?腔内修复术紧急干预88例，非紧急干预70例，术后30 d死亡率为9.5%（15/158）。术后30 d死亡单因素分析显示，紧急干预患者术后30 d死亡率显著高于非紧急干预患者［13.6%（12/88）对4.3%（3/70），χ2=3.967，P=0.046］；术后30 d死亡组患者气管分叉平面假腔面积占该平面主动脉管腔总面积≥50%患者［93.3%（14/15）对0.7%（1/143），χ2=135.581，P＜0.001］和重要分支血管受累患者［66.7%（10/15）对 32.9%（47/143），χ2=6.725，P=0.010］显著高于术后30 d生存组患者；两组患者破口位置、破口大小、降主动脉最大直径、气管分叉平面主动脉直径、假腔状态、腹主动脉是否受累比较，差异无统计学意义（P＞0.05）。Logistic回归多因素分析显示，紧急干预（OR=1.31，95%CI=1.08～3.53，P=0.026）和气管分叉平面假腔面积占该平面主动脉管腔总面积≥50%（OR=9.53，95%CI=3.69～12.47，P＜0.001）是Stanford B型主动脉夹层腔内修复术后30 d死亡的独立危险因素。结论?术前MSCT对预测Stanford B型主动脉夹层腔内修复术后患者早期死亡具有重要价值，紧急干预和气管分叉平面假腔面积占主动脉管腔总面积≥50%是术后30 d死亡的独立危险因素。

参考文献/References:

[1] Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection[J]. J Am Coll Cardiol, 2015, 66: 350-358.
[2] Lu D, Li CL, Lü WF, et al. Diagnostic value of multislice computerized tomography angiography for aortic dissection: a comparison with DSA[J]. Exp Ther Med, 2017, 13: 405-412.
[3] Fioranelli A, Razuk Filho A, Castelli Junior V, et al. Mortality within the endovascular treatment in Stanford type B aortic dissections[J]. Rev Bras Cir Cardiovasc, 2011, 26: 250-257.
[4] Ruan ZB, Zhu L, Chen GC, et al. Early and Long-term effect of thoracic endovascular aortic repair for Stanford B aortic dissection[J]. Thorac Cardiovasc Surg, 2015, 63: 120-125.
[5] Hughes GC, Andersen ND, McCann RL. Management of acute type B aortic dissection[J]. J Thorac Cardiovasc Surg, 2013, 145（3 Suppl）: S202-S207.
[6] Lim CY. Endovascular repair in acute complicated type B aortic dissection: 3-year results from the valiant US investigational device exemption study[J]. Korean J Thorac Cardiovasc Surg, 2017, 50: 137-143.
[7] Bavaria JE, Brinkman WT, Hughes GC, et al. Outcomes of thoracic endovascular aortic repair in acute type B aortic dissection: results from the valiant United States investigational device exemption study[J]. Ann Thorac Surg, 2015, 100: 802-809.
[8] 王国权， 翟水亭， 李天晓， 等. Stanford B型主动脉夹层腔内修复术后死亡原因分析[J]. 介入放射学杂志， 2015， 24：950-953.
[9] 李?庆， 黄连军， 许尚栋， 等. StanfordB主动脉夹层患者腔内修复术的疗效观察[J]. 中华医学杂志， 2013， 93：1469-1471.
[10] Patterson B, De Bruin JL, Brownrigg JR, et al. Current endovascular management of acute type B aortic dissection. Whom should we treat and when?[J]. J Cardiovasc Surg （Torino）, 2014, 55: 491-496.
[11] Kitamura T, Torii S, Oka N, et al. Key success factors for thoracic endovascular aortic repair for non-acute Stanford type B aortic dissection[J]. Eur J Cardiothorac Surg, 2014, 46: 432-437.
[12] Virtue Registry Investigators. The VIRTUE Registry of type B thoracic dissections: study design and early results[J]. Eur J Vasc Endovasc Surg, 2011, 41: 159-166.
[13] Booher AM, Isselbacher EM, Nienaber CA, et al. The IRAD classification system for characterizing survival after aortic dissection[J]. Am J Med, 2013, 126: 730. e19-730. e24.
[14] Smedberg C, Hultgren R, Delle M, et al. Temporal and morphological patterns predict outcome of endovascular repair in acute complicated type B aortic dissection[J]. Eur J Vasc Endovasc Surg, 2018, 56: 349-355.
[15] Evangelista A, Salas A, Ribera A, et al. Long-term outcome of aortic dissection with patent false lumen: predictive role of entry tear size and location[J]. Circulation, 2012, 125: 3133-3141.
[16] Kudo T, Mikamo A, Kurazumi H, et al. Predictors of late aortic events after Stanford type B acute aortic dissection[J]. J Thorac Cardiovasc Surg, 2014, 148: 98-104.
[17] Kitamura T, Torii S, Oka N, et al. Impact of the entry site on late outcome in acute Stanford type B aortic dissection[J]. Eur J Cardiothorac Surg, 2015, 48: 655-662.
[18] Li D, Ye L, He Y, et al. False lumen status in patients with acute aortic dissection: a systematic review and meta-analysis[J]. J Am Heart Assoc， 2016， 5: e003172.

相似文献/References:

[1]王茂华,金 星,吴学君. 腔内修复术成功救治外伤性主动脉夹层伴截瘫一例[J].介入放射学杂志,2012,(12):1059.
　WANG Mao? hua,JIN Xing,WU Xue? jun.. The traumatic aortic dissection accompanied by paraplegia successfully treated with endovascular repair： report of one case[J].journal interventional radiology,2012,(04):1059.
[2]张晔青,李晓强.Stanford A型夹层并发右下肢及肠缺血误诊一例[J].介入放射学杂志,2014,(01):11.
　ZHANG Ye? qing,LI Xiao? qiang.. Misdiagnosis of Stanford type A aortic dissection complicated by ischemia of right lower limb and intestine： report of one case[J].journal interventional radiology,2014,(04):11.
[3]戚光祖,邴学华. 腔内修复联合动脉旁路术治疗近端锚定区不足的主动脉夹层[J].介入放射学杂志,2013,(09):727.
　QI Guang? zu,BING Xue? hua.. Endovascular repair combined with arterial bypass for the treatment of aortic dissection with insufficient proximal anchorage zone[J].journal interventional radiology,2013,(04):727.
[4]王志伟,王家祥,李 震,等. 无钙化B型主动脉壁间血肿的治疗[J].介入放射学杂志,2014,(03):210.
　WANG Zhi? wei,WANG Jia? xiang,LI Zhen,et al. Conservative treatment of type B aortic intramural hematoma with no calcification[J].journal interventional radiology,2014,(04):210.
[5]侯钦茂,冯家烜,张荣杰,等.Stanford B型主动脉夹层腔内介入治疗时机对预后的影响 [J].介入放射学杂志,2018,27(04):310.
　HOU Qinmao,FENG Jiaxuan,ZHANG Rongjie,et al.The effect of timing of TEVAR on the prognosis of patients with Stanford type B aortic dissection [J].journal interventional radiology,2018,27(04):310.
[6]边 云,王 莉,陆建平,等.640层容积CT对Stanford B型主动脉夹层腔内隔绝术后随访的应用价值[J].介入放射学杂志,2012,(11):912.
[7]周静文,陈德基,林少芒,等.左锁骨下动脉“烟囱”技术在胸主动脉夹层腔内修复术中的应用[J].介入放射学杂志,2015,(08):668.
　ZHOU Jing- wen,CHEN De- ji,LIN Shao- mang,et al.The application of “chimney” technique of left subclavian artery in performing endovascular repair procedure for Stanford type B aortic dissection[J].journal interventional radiology,2015,(04):668.
[8]保广鹤,李焕祥,马彦寿.裸支架烟囱技术治疗主动脉夹层伴左颈总动脉破口[J].介入放射学杂志,2015,(09):767.
　BAO Guang- he,LI Huan- xiang,MA Yan- shou.The application of bare- stent“chimney” technique in treating aortic dissection complicated by left common carotid rupture[J].journal interventional radiology,2015,(04):767.
[9]吕俊远,王 雷,杨春卿,等.中心线法测量B型主动脉夹层锚定区的初步研究 [J].介入放射学杂志,2015,(10):857.
　LV Jun- yuan,WANG Lei,YANG Chun- qing,et al.Centerline analysis for the measurement of aortic diameter at proximal landing zone in type B aortic dissection： a preliminary study[J].journal interventional radiology,2015,(04):857.
[10]逯党辉,翟水亭,李天晓,等.复合手术治疗Stanford B型胸主动脉夹层 [J].介入放射学杂志,2015,(10):897.
　LU Dang-hui,ZHAI Shui-ting,LI Tian-xiao,et al.Hybrid operation for the treatment of Stanford type B aortic dissection[J].journal interventional radiology,2015,(04):897.

备注/Memo

备注/Memo:
（收稿日期：2019-04-22）
（本文编辑：边?佶）
更新日期/Last Update: 2020-05-06