TEVAR在非复杂型B型主动脉夹层中的作用—2022年STS/AATS B型主动脉夹层管理临床实践指南解读
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作者单位:

1.中南大学湘雅二医院 血管外科,湖南 长沙 410011;2.中南大学血管病研究所,湖南 长沙 410011;3.中国医学科学院阜外医院 血管外科,北京 100037;4.国家心血管病中心,北京 100037

作者简介:

舒畅,中南大学湘雅二医院主任医师,主要从事血管外科临床与基础方面的研究。

基金项目:

国家自然科学基金资助项目(82120108005);国家自然科学基金国际(地区)合作与交流基金资助项目(8211001122)。


Role of TEVAR in non-complex type B aortic dissection —interpretation of 2022 STS/AATS clinical practice guidelines on the management of type B aortic dissection
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1.Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha 410011, China;2.Institute of Vascular Disease, Central South University, Changsha 410011, China;3.Department of Vascular Surgery, Fuwai Hospital, Academy of Medical Sciences, Beijing 100037, China;4.National Center for Cardiovascular Disease, Beijing 100037, China

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    摘要:

    在非复杂型B型主动脉夹层的治疗中,中西方学界一直存在分歧,既往欧美指南强调保守治疗。但随着TBAD患者长期随访数据的不断增多和腔内技术的广泛应用与改进,TEVAR在非复杂型B型主动脉夹层中的有效作用在西方学界亦逐渐得到公认,并在今年的美国STS/AATS指南得到了阐述。因此,本文对指南中相关部分进行了解读,供学者们参考讨论。

    Abstract:

    In the treatment of non-complicated type B aortic dissection (TBAD), disagreement exists between Chinese and Western academic associations, and previous European and American guidelines emphasized conservative treatment. However, with the increase of long-term follow-up data of TBAD patients and the extensive application and improvement of endovascular techniques, the effective role of TEVAR in non-complicated TBAD has gradually been recognized by Western academic community, and has been elaborated in this year's American STS/AATS guideline. Therefore, this paper interprets the relevant parts of the guideline for discussion among professional scholars.

    表 1 TBAD临床表现分型Table 1 Classification of clinical manifestations of TBAD
    表 2 可能晚期预后不良的形态学特征Table 2 Morphological features with potential poor late outcomes
    图1 急性TBAD诊治策略(对于复杂型TBAD,推荐急诊TEVAR手术,对于解剖学不合适TEVAR的患者可考虑杂交或开胸手术;对于高风险型TBAD,推荐限期行TEVAR手术;对于非复杂型TBAD,推荐OMT治疗,其中解剖学合适的患者,可考虑行TEVAR治疗减少远期主动脉并发症;对于所有TBAD患者,均建议需长期持续密切随访+OMT治疗)Fig.1 Strategies for diagnosis and treatment of acute TBAD (for complicated TBAD, emergency TEVAR surgery is recommended, and for patients who are anatomically inappropriate to perform TEVAR, hybrid or thoracotomy surgery can be considered; for high-risk TBAD, TEVAR surgery is recommended within a limited time; OMT treatment is recommended for non-complicated TBAD, and TEVAR treatment can be considered for anatomically appropriate patients to reduce long-term aortic complications; for all TBAD patients, long-term and continuous close follow-up plus OMT therapy is recommended)
    图1 急性TBAD诊治策略(对于复杂型TBAD,推荐急诊TEVAR手术,对于解剖学不合适TEVAR的患者可考虑杂交或开胸手术;对于高风险型TBAD,推荐限期行TEVAR手术;对于非复杂型TBAD,推荐OMT治疗,其中解剖学合适的患者,可考虑行TEVAR治疗减少远期主动脉并发症;对于所有TBAD患者,均建议需长期持续密切随访+OMT治疗)Fig.1 Strategies for diagnosis and treatment of acute TBAD (for complicated TBAD, emergency TEVAR surgery is recommended, and for patients who are anatomically inappropriate to perform TEVAR, hybrid or thoracotomy surgery can be considered; for high-risk TBAD, TEVAR surgery is recommended within a limited time; OMT treatment is recommended for non-complicated TBAD, and TEVAR treatment can be considered for anatomically appropriate patients to reduce long-term aortic complications; for all TBAD patients, long-term and continuous close follow-up plus OMT therapy is recommended)
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舒畅. TEVAR在非复杂型B型主动脉夹层中的作用—2022年STS/AATS B型主动脉夹层管理临床实践指南解读[J].中国普通外科杂志,2022,31(12):1557-1563.
DOI:10.7659/j. issn.1005-6947.2022.12.001

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  • 收稿日期:2022-07-25
  • 最后修改日期:2022-11-27
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  • 在线发布日期: 2023-01-08