复旦博导8年研究终获成功 成果文章登权威期刊

　　

生物通报道，上海复旦大学附属中山医院血管外科符伟国教授在StanfordB型主动脉夹层腔内修复术研究上取得最新进展，相关论文发表于《循环》上[Circulation 2009，119（5）:735]。

 

《循环》是国际最负盛名的心血管学术杂志，长期以来在全球心血管病学、血液病学以及外周血管病学杂志中均排名第一，最新影响因子12.755。

 

主动脉夹层病情凶险，死亡率高，国人发病率高于西方国家，以往主要依赖手术治疗，但是创伤巨大，死亡率和截瘫率高。腔内修复是一种新的微创治疗方法，可明显降低死亡率和并发症率，已经成为Stanford B型夹层治疗的主要发展趋势。

 

 

据医药论坛报报道，符伟国等对接受腔内修复治疗的443例主动脉夹层患者进行3~50个月随访，总结出主动脉夹层发生的原因与多种因素有关，包括病程进展、动脉壁脆弱和支架相关因素等。研究者提出了避免对马方（Marfan）综合征患者进行主动脉弓内治疗，对主动脉弓扭曲畸形或有Marfan综合征者应优选无弹簧圈的腔内支架，以及规范腔内操作等针对性预防措施。研究人员还发现逆行性A型夹层是主动脉夹层腔内修复术后尤其是围手术期首位的致死原因，其发生率2.5%，死亡率高达27.3%。这一研究结果对提高腔内修复的安全性和有效性具有积极意义。

 

符伟国介绍，在美国主动脉夹层年发病率为2.9～3.5例/10万人，我国缺乏该病流行病学资料，但在临床实践中，“中国主动脉夹层的发病率明显高于欧美”已经成为各国学者的共识，我国每年的发病人数超过5万例。

 

《循环》杂志评价该研究是“对胸主动脉腔内治疗一种重要并发症的及时报道”。

 

我国血管外科作为独立学科发展历史较短，但通过老一辈血管外科专家的努力，我国血管外科在血栓闭塞性脉管炎、断肢再植、多发性大动脉炎、布加综合征等疾病的治疗中取得了举世瞩目的成就，并已达到世界先进水平。然而，在主动脉疾病外科治疗方面，我国和发达国家仍有差距，因而该项研究成果标志着我国在主动脉夹层的腔内治疗上达到国际前沿地位。

原文检索

Retrograde Type A Aortic Dissection After Endovascular Stent Graft Placement for Treatment of Type B Dissection

Zhi Hui Dong, MD; Wei Guo Fu, MD; Yu Qi Wang, MD; Da Qiao Guo, MD; Xin Xu, MD; Yuan Ji, MD; Bin Chen, MD; Jun Hao Jiang, MD; Jue Yang, MD; Zhen Yu Shi, MD; Ting Zhu, MD; Yun Shi, MD

From the Departments of Vascular Surgery (Z.H.D., W.G.F., Y.Q.W., D.Q.G., X.X., B.C., J.H.J., J.Y., Z.Y.S., T.Z., Y.S.) and Pathology (Y.J.), Zhongshan Hospital, Fudan University, Shanghai, China.

 

Correspondence to Wei Guo Fu, MD, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai 200032, China. E-mail [e-mail]

 

Received January 8, 2008; accepted December 5, 2008.

 

Background— Retrograde type A aortic dissection has been deemed a rare complication after endovascular stent graft placement for type B dissection. However, this life-threatening event appears to be underrecognized and is worth being investigated further.

 

Methods and Results— Eleven of 443 patients developed retrograde type A aortic dissection during or after stent grafting for type B dissection from August 2000 to June 2007. Of these 11 patients, 3 had Marfan syndrome. The Kaplan–Meier estimate of the rate of freedom from this event at 36 months is 97.4% (95% confidence interval, 0.95 to 0.99). The new entry was located at the tip of the proximal bare spring of the stent graft in 9 patients, was within the anchoring area of the proximal bare spring in 1, and remained unknown in 1 patient. Eight patients were converted to open surgery, and 2 received medical treatment. One patient suddenly died 2 hours after the primary stent grafting, and 2 died within 1 week after the surgical conversion, so mortality reached 27.3%. During the follow-up from 3 to 50 months, type I endoleak was identified in 1 patient 3 months after the surgical exploration and disappeared at 6 months.

 

Conclusions— Retrograde type A aortic dissection after stent grafting for type B dissection appears not to be rare and results from mixed causes. Fragility of the aortic wall and disease progression may predispose to it, whereas stent grafting–related factors make important and provocative contributions. Avoiding aortic arch stent grafting in Marfan patients, preferably selecting the endograft without the proximal bare spring for patients with a kinked aortic arch or with Marfan syndrome (if endografting is used), improving the device design, and standardizing endovascular manipulation might lessen its occurrence.