Glower D D, Fann J I, Speier R H, Morrison L, White W D, Smith L R, Rankin J S, Miller D C, Wolfe W G
Department of Surgery, Duke University Medical Center, Durham, N.C. 27710.
Circulation. 1990 Nov;82(5 Suppl):IV39-46.
To guide the choice of medical versus surgical therapy for patients with descending (type B) aortic dissection (tear in the descending aorta without involvement of the ascending aorta), multivariate survival analysis was applied to 136 patients admitted to two medical centers between 1975 and 1988 with acute (n = 89) or chronic (n = 47) descending dissection: group 1, all 136 patients; group 2, 106 patients without rupture, pulse loss, or visceral organ compromise; and group 3, 56 patients from group 2 without major cardiac or renal disease (23 surgical and 33 medical). Group 3 medical and surgical subgroups were well matched for baseline characteristics and were potential candidates for either mode of therapy. By Cox model analysis, significant predictors of mortality were pleural rupture, other dissection complications, increasing age, and cardiac disease (all p less than 0.01). Surgical versus medical therapy was not an independent determinant of survival in any of the three groups for acute or chronic dissection. Survival probabilities for all group 3 patients at 1, 5, and 10 years were 0.94, 0.87, and 0.32 (medical) and 0.90, 0.80, and 0.50 (surgical). Despite the limitations of this retrospective study (including the possibility of undefined treatment selection biases), these data suggest that medical or early surgical therapy is associated with equivalent outcome in selected patients with uncomplicated acute or chronic descending aortic dissection.
为指导降主动脉（B型）夹层（降主动脉撕裂但升主动脉未受累）患者选择药物治疗还是手术治疗，对1975年至1988年间入住两个医疗中心的136例急性（n = 89）或慢性（n = 47）降主动脉夹层患者进行了多因素生存分析：第1组为全部136例患者；第2组为106例无破裂、脉搏消失或内脏器官受损的患者；第3组为第2组中无严重心脏或肾脏疾病的56例患者（23例手术治疗，33例药物治疗）。第3组的药物治疗和手术治疗亚组在基线特征方面匹配良好，是两种治疗方式的潜在候选对象。通过Cox模型分析，死亡率的显著预测因素为胸膜破裂、其他夹层并发症、年龄增加和心脏病（均p<0.01）。对于急性或慢性夹层，在三组中的任何一组中，手术治疗与药物治疗均不是生存的独立决定因素。第3组所有患者1年、5年和10年的生存概率分别为0.94、0.87和0.32（药物治疗）以及0.90、0.80和0.50（手术治疗）。尽管这项回顾性研究存在局限性（包括可能存在未明确的治疗选择偏倚），但这些数据表明，在选定的无并发症急性或慢性降主动脉夹层患者中，药物治疗或早期手术治疗的结局相当。
