摘要胸主动脉腔内修复术是治疗 Stanford B 型主动脉夹层（TBAD）的标准术式。对于远端破口的处理时机与处理方式，目前学界仍存在争议。远端破口在假腔重塑过程中，可能发挥两种相反作用：既可阻碍假腔血栓形成，又可通过释放假腔压力，进而降低夹层动脉瘤的发生风险。本文从远端破口影响夹层发展的生理机制入手，对当前的治疗策略与治疗适应证进行综述。当前，由于缺乏高质量临床证据，在制定治疗决策时，需强调个体化评估的重要性，并重视术后定期随访。随着人工智能技术和血流动力学分析等手段不断发展，有望为TBAD的精准治疗提供更多支持。

abstractsThoracic endovascular aortic repair is the standard procedure for treating Stanford type B aortic dissection (TBAD). The timing and approach for managing distal entry tears remain controversial. During false lumen remodeling, distal tears may exert two opposing effects: they can impede thrombus formation within the false lumen while simultaneously reducing the risk of dissecting aneurysm formation by relieving false lumen pressure. This review examines the physiological mechanisms by which distal tears influence dissection progression, summarizing current treatment approaches and indications. Given the current lack of high-quality clinical evidence, individualized assessment and regular postoperative follow-up are paramount in treatment decision-making. Advances in artificial intelligence and hemodynamic analysis techniques may provide additional support for precision treatment of TBAD.