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目的 总结急性Stanford B型主动脉夹层疾病(aortic dissection,AD)的临床特点,对比腔内修复治疗(endovascular repair,EVR)与保守治疗效果. 方法 回顾性分析2004年1月至2010年10月收治的116例急性Stanford B型AD患者的临床资料,分为EVR组(60例)和保守治疗组(56例),其中EVR组采用覆膜支架植入治疗AD；保守组采用降压镇痛等对症治疗.对2组治疗效果进行统计学评估和比较.结果 116例急性Stanford B型AD患者主要临床表现为:胸背部疼痛(74.1％),CTA检查是确诊主动脉夹层的主要手段.保守组56例患者,入院30 d死亡率为16.1％；EVR组60例患者,移植物均成功释放,30 d死亡率为1.7％明显低于保守组(P＜0.05).保守组和EVR组随访率分别为71.4％和86.7％,平均随访时间分别为(38±16)个月和(35±14)个月,5年生存率保守组和EVR组分别为87.5％和88.5％,差异无统计学意义(P＞0.05).结论 腔内支架植入治疗是急性Stanford B型主动夹层的首选方法,能够提高患者30 d生存率；保守治疗也仍然是一种治疗选择.

Objectives To compare endovascular aortic repair (EVR) and medical therapy for acute type B aortic dissection (AD) in terms of treatment results.Methods From January 2004 to October 2010 116 cases were collected and were divided into two groups,with treatment of EVR (n =60)and medical therapy (n ＝ 56).Treatment outcomes were assessed.Results Clinical manifestations of AD are complex and variable,with the most common symptom being pain on chest and back (74.1％).CTA is the most valuable method in confirming the diagnosis of aortic dissection.In conservative group of 56 patients admitted to hospital,30-day mortality rate was 16.1％.In EVR group of 60 patients with grafts successfully released,the 30-day mortality was 1.7％.There is significant difference between the two groups on mortality rate during 30-day(P ＜0.05).Follow-up rate in conservative group and the EVR group was 71.4％ and 86.7％,with average follow-up time of (38 ± 16) months and (35 ± 14) months.The 5-year survival rates were 87.5％ and 88.5％ respectively in conservative group and EVR group (P ＞ 0.05).Conclusions EVR is considered to be the first choice for acute Stanford type B dissection.EVR can improve patients' 30-day survival,though long term result is comparable with that of conservative treatment.