临床外科杂志 ›› 2021, Vol. 29 ›› Issue (6): 526-529.doi: 10.3969/j.issn.1005-6483.2021.06.009

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杂交手术与支架象鼻术治疗复杂性B型主动脉夹层的近中期疗效分析及并发症危险因素的Logistic回归分析

  

  1. 青海省心脑血管病专科医院心脏外科
  • 出版日期:2021-06-20 发布日期:2020-06-20

Logistic regression analysis of shortterm and midterm outcomes and risk factors of complications between hybrid operation and Bracket Elephant trunk technique for complex type B aortic dissection

  • Online:2021-06-20 Published:2020-06-20

摘要: 目的:分析杂交手术与支架象鼻术治疗复杂性B型主动脉夹层的近中期疗效及并发症危险因素。方法:2011年1月~2018年1月治疗的复杂性B型主动脉夹层老年病人72例,其中行杂交手术47例,行支架象鼻术25例,比较两组病人围手术期临床指标、近期疗效、中期疗效,分析并发症的危险因素。结果:杂交手术组手术时间、术中出血量、造影剂使用量以及住院时间低于支架象鼻术组;手术后以及手术后1个月,两组病人的主动脉假腔均明显下降(P<0.05),假腔直径达到预期目标;术后12个月,杂交手术组病人的并发症率(17.02%)低于支架象鼻术组(56.00%);并发症组与非并发症组病人难治性高血压、吸烟史以及手术前主动脉最大直径比较差异有统计学意义(P<0.05);难治性高血压、吸烟史以及手术前主动脉最大直径均可作为术后并发症的独立危险因素。结论:复杂性B型主动脉夹层病人行杂交手术,其近期疗效与支架象鼻术病人一致,远期效果优于后者。病人吸烟史、术前主动脉直径以及难治性高血压病史均为术后并发症的高危因素。

关键词: 杂交手术, 支架象鼻术, 主动脉夹层, 并发症, 危险因素

Abstract: Objective:To investigate the difference of shortterm and midterm efficacy and risk factors of complications between hybrid operation and Bracket Elephant trunk technique in the treatment of complex type B aortic dissection.Methods:A retrospective analysis was made on 72 patients with complex type B aortic dissection treated in our hospital from January 2011 to January 2018.47 patients underwent hybrid operation and 25 patients underwent Bracket Elephant trunk technique.The differences of perioperative clinical indexes,shortterm curative effect,mediumterm curative effect and risk factors of complications between the two groups were compared.Result:The operation time,intraoperative bleeding volume,contrast medium usage and hospitalization time in the hybridization group were significantly lower than those in the Bracket Elephant trunk technique group;the aortic pseudocavities of the two groups decreased significantly after operation and one month after operation(P<0.05);Complication rate(17.02%) in the hybridization group was significantly lower than that in the Bracket Elephant trunk technique group(56.00%);Complication group and noncomplication group had significant differences in refractory hypertension,smoking history and aortic maximum diameter before operation(P< 0.05).Refractory hypertension,refractory hypertension,and aortic maximum diameter before operation(P<0.05).Smoking history and preoperative aortic maximum diameter can be used as independent risk factors for postoperative complications.Conclusion:Hybridization for complex type B aortic dissection has the same shortterm effect as Bracket Elephant trunk technique,and the longterm effect is better than the latter.At the same time,smoking history,preoperative aortic diameter and refractory hypertension history are highrisk factors for postoperative complications.

Key words: hybrid surgery, bracket elephant trunk technique, aortic dissection, complications, risk factors

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