胸主动脉腔内修复术中同期行左锁骨下动脉原位开窗法——“J.D”法  

"J.D"technique:A method for in situ fenestration of left subclavian artery in thoracic endovascular aortic repair

作　　者：刘冀东[1] 杨文钢[1] 顾剑民[1] 薛松[1] LIU Jidong;YANG Wengang;GU Jianmin;XUE Song(Department of Cardiovascular Surgery,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai,200127,P.R.China)

机构地区：[1]上海交通大学医学院附属仁济医院心血管外科,上海200127

出　　处：《中国胸心血管外科临床杂志》2020年第4期450-453,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：浦东新区卫生和计划生育委员会科技项目(PW2015D-2);申康专科疾病临床“五新”转化项目(16CR3086B)。

摘　　要：目的报道一种胸主动脉腔内修复术(TEVAR)中左锁骨下动脉(LSA)原位开窗法—"J. D"法。方法 2018年6月至2019年5月我中心28例患者行TEVAR中同期原位开窗,男23例、女5例,平均年龄(57.7±9.6)岁。其中12例患者采用常规可调弯鞘/不同形态导引导管法(A组),16例患者采用"J. D"法(B组)。比较两组患者的临床疗效。结果 A组1例转为"烟囱"术式。B组15例患者均成功完成,鞘管导向良好,穿刺破膜点均位于近左锁骨下开口中点;另1例患者由于术中牵引系统移位,改为传统的可调弯鞘法穿刺完成手术。对比两组患者对位-破膜时间、击发次数及并发症,B组均有明显优势。近期随访两组内漏无明显差异。结论应用"J. D"法行TEVAR术中同期LSA原位开窗,简洁、安全,有效降低了目前LSA原位开窗时鞘管对位不良所致风险。近期随访结果与传统方法无明显差异。但该法仍需进一步累积病例数量以观察可能存在的风险及困难。Objective To report a simple and safe method for in situ fenestration of left subclavian artery in thoracic endovascular aortic repair(TEVAR).Methods Twenty-eight patients received in situ fenestration of left subclavian artery in TEVAR from June 2018 to May 2019 in our center,including 23 males and 5 females at an average age of 57.7±9.6 years.Among them,12 patients used adjustable sheath or guiding catheter(a group A)and 16 patients used"J.D"technique(a group B).The clinical efficacy of the two groups was compared.Results In the group A,1 patient failed to receive fenestration and was transferred to the chimney technique.In the group B,1 patient due to the traction system shift during operation,was completed by traditional adjustable sheath puncture.The group B had shorter alignmentperforation time and trigger time and less complications.There was no significant difference in endoleak during shortterm follow-up between the two groups.Conclusion The"J.D"technique is simple,safe and easy to obtain materials.It effectively reduces the risk caused by difficult sheath alignment during the in situ fenestration of the left subclavian artery.Although the results of recent follow-up are not significantly different from traditional methods,it still needs to accumulate the cases to observe the possible risks and difficulties.

关 键 词：胸主动脉腔内修复术 左锁骨下动脉 原位开窗 

分 类 号：R654.3[医药卫生—外科学]