体外开窗技术治疗主动脉弓病变的疗效分析  

Clinical effect of in vitro fenestration stent-grafts for aortic arch diseases

作　　者：高文韬 武广焱 杨光敏 周敏[2] 李晓强 汤文浩[3] Gao Wentao;Wu Guangyan;Yang Guangmin;Zhou Min;Li Xiaoqiang;Tang Wenhao(School of Medical,Southeast University,Nanjing 210009,China;Department of Vascular Surgery,Affiliated Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China;Department of General Surgery,Zhongda Hospital,Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学医学院,南京210009 [2]南京大学医学院附属鼓楼医院血管外科,南京210008 [3]东南大学附属中大医院普外科,南京210009

出　　处：《中国血管外科杂志（电子版）》2020年第3期201-204,208,共5页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的探讨体外开窗技术在治疗主动脉弓部病变中的疗效。方法回顾性分析南京鼓楼医院2018年5月至2019年9月采用体外开窗技术重建分支血管的40例主动脉弓部病变患者临床资料。结果患者手术均成功,其中重建左锁骨下动脉26例,重建左锁骨下动脉和左颈总动脉4例,重建主动脉弓三分支10例。术后出现脑梗死、肌酐升高各1例,经积极干预后恢复;1例患者出现左下肢动脉栓塞而行急诊取栓术;发生Ⅲ型内漏4例,1例选用更大尺寸覆膜桥接支架扩张后消失,其余未再次干预。术后随访中位时间10个月,无患者死亡,分支支架均畅通。1例患者术后4个月发现Ⅳ型内漏,再次覆盖覆膜支架并使用弹簧圈栓塞远端破口后消失。结论体外开窗技术治疗主动脉弓部病变短期效果满意,远期效果还有待进一步评估。Objective To evaluate the clinical effect of in vitro fenestration stent-grafts for aortic arch diseases.Methods The clinical data of 40 cases of aortic arch diseases who treated by in vitro fenestration stent-grafts in Nanjing Drum Tower Hospital from May 2018 to September 2019 were analyzed retrospectively.Results The operation was successful in all cases,including 26 cases of reconstruction of the left subclavian artery,4 cases of reconstruction of both left subclavian artery and left common carotid artery,and 10 cases of reconstruction of all three branches of the aortic arch.Postoperative cerebral infarction and creatinine increased occurred in one case each,and recovered after active intervention.One case developed left lower extremity arterial embolism and underwent emergency embolectomy.Four cases occurred typeⅢendoleak,and one case resolved by deploying another bridging stent with larger diameter,while no reintervention for the rest.The median follow-up time was 10 months.No patient died,and the branch stents were unobstructed.One case occurred type IV endoleak four months after surgery,,which was solved by overlapping another covered stent and coil embolism in distal intimal tear.Conclusion Short term outcomes of in vitro fenestration stent-grafts for aortic arch diseases are satisfactory.The long-term effects need to be further evaluated.

关 键 词：主动脉弓 体外 开窗 胸主动脉腔内修复术 覆膜支架 

分 类 号：R654.3[医药卫生—外科学]