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目的探讨与分析B型主动脉夹层覆膜支架置入术后支架水平段假腔消失的影响因素。方法对90例B型主动脉夹层患者行覆膜支架置入治疗,术后采用电子束计算机断层增强扫描进行随访,平均随访13.6±6.6个月(3~25个月)。根据CT结果支架水平段假腔是否消失分为两大组,再根据病变时期急性、亚急性或慢性进一步分为亚组。(1)两组间进行下列变量的计量资料统计分析:测量术前及术后1周内和3~6个月等不同时期CT增强扫描图像支架近段、中段及远段,主肺动脉分叉等水平假腔径线及主动脉总径。(2)两组间进行下列变量的计数资料统计分析:性别、病变分期、高血压有否、假腔位置、支架类型、左锁骨下动脉是否完全覆盖及术后造影是否有内漏等。P<0.05为差异有统计学意义。结果CT随访中共有12例支架水平段假腔消失。两组CT测量数据计量资料统计分析,应用t检验显示术前对应支架近中段及主肺动脉分叉水平主动脉的直径在两组间差异有统计学意义,即术前降主动脉上中段直径在两组间差异有统计学意义。两组计数资料进行卡方检验显示急性、亚急性及慢性分期在两组间差异有统计学意义,亚急性期为有益因素,假腔消失组距离发病平均时间为26.0±17.7天。结论覆膜支架置入时期的不同及术前降主动脉上中段直径的不同,是影响B型主动脉夹层覆膜支架置入术后支架水平段假腔是否消失的重要因素。
Objective To investigate and analyze the influencing factors of the disappearance of the false lumen at the level of stent after B type aortic dissection. Methods Ninety patients with type B aortic dissection were treated with stent implantation. The patients were followed up by electron beam computed tomography (CT) scan for an average of 13.6 ± 6.6 months (range 3 to 25 months). According to the results of CT scaffold horizontal section of the false lumen is divided into two groups, according to the lesion during acute, subacute or chronic further divided into subgroups. (1) The statistical analysis of the measurement data of the following variables between the two groups: measurement of the proximal, middle and distal segments of the stent, the main pulmonary artery bifurcation in the preoperative and postoperative 1 week and 3-6 months Equal horizontal foci diameter and aortic diameter. (2) The statistical analysis of the count data of the following variables: gender, stage of disease, hypertension, false lumen location, stent type, whether the left subclavian artery is completely covered and whether there is leakage after operation. P <0.05 for the difference was statistically significant. Results In the CT follow-up, there were 12 cases of false lumen disappearing at the level of stent. Statistical analysis of measurement data of two sets of CT measurement data showed that there was a significant difference between the two groups in the diameter of the aorta corresponding to the proximal and middle branches of the stent and the level of the main pulmonary artery bifurcated by t- The difference between the two groups was statistically significant. Chi-square test showed that the acute, subacute and chronic staging of the two groups were statistically significant differences between the two groups, the subacute period for the beneficial factors, false-disappeared group, the average time of onset of disease was 26.0 ± 17.7 days. Conclusions The difference of the placement time of stent-graft and the diameter of the middle and upper descending aorta before operation is an important factor that influences the disappearance of the false lumen in the horizontal segment of stent-graft after the stent-graft of B-type aortic dissection.