腔内修复术治疗 Stanford B 型主动脉夹层的效果观察

Effect of Endovascular Repair on Stanford Type B Aortic Dissection

摘要:

〔摘 要〕 目的：探讨 Stanford B 型主动脉夹层（TBAD）患者给予腔内修复术（EVAR）治疗对炎症因子、血管 内皮生长因子（VEGF）的影响及预后。方法：选取 2020 年 1 月至 2021 年 1 月在河南省胸科医院治疗的 TBAD 患者 47 例作为研究对象，均给予 EVAR 治疗，统计患者围手术期指标及预后情况，比较手术前后患者的炎症因子、VEGF 水平变化。结果：47 例患者的术中出血量平均为（32.41 ± 5.48）mL，手术时间平均为（1.52 ± 0.41）h，重症监护室 （ICU）入住时间平均为（13.34 ± 3.02）h，住院时间平均为（17.24 ± 3.45）d；术后 7 d 白细胞介素 –1β（IL–1β）、 白细胞介素 –8（IL–8）、C 反应蛋白（CRP）、肿瘤坏死因子 –α（TNF–α）水平较术前降低，差异均具有统计学意义 （P ＜ 0.05）；术后 7 d VEGF 水平较术前降低，差异具有统计学意义（P ＜ 0.05）；患者中有 5 例发生并发症，发 生率为 10.64 %，其中 2 例内漏，1 例夹层破裂，2 例胸腔积液，未发生肾功能障碍；随访 1 年，共 3 例患者再介入治疗， 占 6.38 %，1 例死亡，病死率为 2.13 %。结论：TBAD 患者给予 EVAR 治疗，术中出血量较少，手术时间短，患者恢 复快，能够改善炎症因子、VEGF 水平，预后较好。

Abstract:

〔Abstract〕 Objective To investigate the effects of endovascular aneurysm repair (EVAR) on inflammatory factors and vascular endothelial growth factor (VEGF) and prognosis in Stanford type B aortic dissection (TBAD) patients. Methods A total of 47 patients with TBAD who were treated in Henan Provincial Chest Hospital from January 2020 to January 2021 were selected as the research subjects, all patients were treated with EVAR. The perioperative indicators and prognosis of the patients were counted, and the inflammatory factors, VEGF level changes of the patients before and after the operation were compared. Results The average intraoperative blood loss of the 47 patients was (32.41 ± 5.48) mL, the average operation time was (1.52 ± 0.41) h, the average intensive care unit (ICU) stay time was (13.34 ± 3.02) h, and the average hospitalization time was ( 17.24 ± 3.45) d; interleukin-1β (IL-1β), interleukin-8 (IL-8), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) levels after surgery 7 days compared with preoperative, the differences were statistically significant (P < 0.05); After operation 7 days, the VEGF level was decreased compared with preoperative, and the difference was statistically significant (P < 0.05). Complications occurred in 5 patients, the incidence rate was 10.64%, including 2 cases of endoleak, 1 case of dissection rupture, 2 cases of pleural effusion, and no renal dysfunction; followed up for 1 year, a total of 3 patients received re-intervention treatment, accounting for 6.38%, 1 case died, and the mortality rate was 2.13%. Conclusion TBAD patients treated with EVAR have less intraoperative blood loss, shorter operation time, faster recovery, and can improve the levels of inflammatory factors and VEGF, and have a better prognosis.