主动脉腔内修复术置入覆膜支架长度与效果的临床研究Clinical study on length and effect of implantation of stent graft in aortic endovascular repair
刘轩泽,王效增,李智佳,周铁楠,刘海伟,荆全民
摘要(Abstract)：
目的评价主动脉覆膜支架长度对行胸主动脉腔内修复术(TEVAR)的急性主动脉综合征(AAS)患者近、远期预后的影响。方法选取2007年1月至2018年7月就诊于北部战区总医院并行TEVAR治疗的AAS患者共931例,剔除临床及随访资料不全的患者,最终有852例入选本研究。根据TEVAR中所用支架长度,将患者分为长支架组(支架长度≥150 mm,613例)与短支架组(支架长度<150 mm,239例),观察其在院期间、术后30 d、1年期间的不良临床事件的发生情况,比较两组患者术后近期和远期的临床效果。结果长支架组患者年龄,入院舒张压,以及男性、有饮酒史、内膜破口距离左锁骨下动脉开口<20 mm的比例均高于短支架组,差异均有统计学意义(均P<0.05)。住院期间,长支架组新发出血性卒中发生率明显低于短支架组(0.2%比1.3%,P=0.036),差异有统计学意义。30 d随访时长支架组总体不良事件发生率明显低于短支架组(4.0%比8.1%,P=0.025),差异有统计学意义;长支架组主动脉相关不良事件的发生率有低于短支架组的趋势(2.6%比5.4%,P=0.063),但两组比较差异无统计学意义。1年随访时长支架组再发主动脉夹层(0.5%比2.7%,P=0.011)、主动脉相关不良事件(3.8%比7.7%,P=0.034)、总体不良事件(6.8%比11.5%,P=0.040)的发生率均低于短支架组,差异均有统计学意义;30 d及1年两组间全因死亡、新发卒中等并发症的发生率比较,差异均无统计学意义(均P>0.05)。Kaplan-Meier生存曲线分析显示,TEVAR术中置入长支架组的患者主动脉相关不良事件的发生率明显低于短支架组患者(P=0.034)。结论单中心资料表明,对于AAS患者,行TEVAR治疗时选用长支架显著降低术后近期、远期主动脉相关不良事件及总体不良事件发生率。
关键词(KeyWords)： 主动脉腔内修复术;支架长度;预后
基金项目(Foundation): 辽宁省科技攻关计划项目(2012005009)
作者(Author): 刘轩泽,王效增,李智佳,周铁楠,刘海伟,荆全民
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