摘要目的 探讨第二代覆膜支架进行Stanford B型主动脉夹层腔内修复术(TEVAR)后患者早期及中期疗效.方法 2009年1月至2013年1月间北京安贞医院大血管中心对383例急性和43例亚急性152例慢性Stanford B型主动脉夹层患者行腔内治疗术.术后患者随访平均(27±14)个月,随访率99.6％,所有临床数据采用SPSS 17.0统计软件统计分析.结果 早期死亡率0.35％(2例),并发症发生率1.2％(6例内漏和3例脑梗死),出院后死亡率:0.35％(2例)；严重并发症发生率5.5％(3例支架近端新破口并逆撕成A型夹层,26例支架远端新破口,3例内漏,0例截瘫).再治疗率:5.2％(转手术治疗6例,再次腔内治疗24例,术后均无死亡和严重并发症).结论 本组Stanford B型主动脉夹层应用第二代覆膜支架腔内治疗后早期和中期死亡率低,无截瘫,内漏发生率较以往报道的早期应用第一代支架的明显减少.主要并发症是覆膜支架导致的远端新破口,支架的设计仍需改进.

abstractsObjective To retrospectively evaluate early and mid-term results of thoracic endovascular repair (TEVAR) of type B aortic dissection by the second generation of stent graft.Methods From January 2009 to January 2013,383 acute,43 sub-acute and 152 chronic patients with type B aortic dissection underwent TEVAR in our aortic center.The mean follow-up period was (27 ± 14)months.All clinical data were analyzed with SPSS 17.0.Results The 30-day mortality and morbidity were 0.35％ and 1.2％ respectively.The mid-term mortality and morbidity were 0.35％ and 5.5％.Serious complications included retrograde type A dissection (n =3),new tear at the distal end of stent (n =26),endoleak (n =3) and paraplegia (n =0).The retreatment rate was 5.2％ (6 patients were transformed to open operation and 24 patients underwent re-intervention).Conclusions The early and mid-term results of thoracic endovascular repair (TEVAR) of type B aortic dissection by the second generation of stent graft showed lower mortality,no paraplegia and significant reduced endoleaks in comparison with the first generation stent graft.The new distal tear caused by the stent graft became the major complication.The design of the stent graft still need improvement.