烟囱技术重建与单纯封闭左锁骨下动脉在主动脉夹层腔内治疗中的疗效比较  

Chimney technique for reconstruction versus simple occlusion of left subclavian artery in endovascular treatment of aortic dissection

作　　者：张远浩 马心健[1] 赵昌学[1] 马波民 ZHANG Yuan-hao;MA Xin-jian;ZHAO Chang-xue;MA Bo-min(Department of Cardiovascular Surgery,Heze Municipal Hospital,Heze,Shandong 274031,China)

机构地区：[1]山东省菏泽市立医院心脏血管外科,山东菏泽274031

出　　处：《中国临床研究》2021年第3期319-322,共4页Chinese Journal of Clinical Research

摘　　要：目的比较烟囱技术重建与单纯封闭左锁骨下动脉在近端锚定区不足主动脉夹层腔内治疗中的疗效。方法对2016年1月至2019年3月在山东省菏泽市立医院接受主动脉腔内修复术治疗的56例近端锚定区不足主动脉夹层患者进行回顾性研究,根据左锁骨下动脉处理方式的不同分为烟囱重建组26例和单纯封闭组30例。烟囱重建组术中将主体支架封闭左锁骨下动脉并采用烟囱技术进行重建;单纯封闭组术中将主体支架单纯封闭左锁骨下动脉而不行重建。比较两组患者的手术相关指标、术后随访12个月相关指标。结果单纯封闭组的主体支架释放后近端Ⅰ型内漏率及经球囊扩张后近端Ⅰ型内漏率均低于烟囱重建组(12.0%vs 42.3%,P<0.05;0 vs 26.9%,P<0.05),随访期间两组近端Ⅰ型内漏率差异无统计学意义(P>0.05)。两组术后胸主动脉段假腔完全血栓化率、术后真假腔重塑结果差异无统计学意义(P>0.05)。单纯封闭组术后左上肢无力、头晕症状发生率均高于烟囱重建组(P<0.05)。结论烟囱技术重建和单纯封闭左锁骨下动脉治疗近端锚定区不足主动脉夹层,两种方法随访时近端Ⅰ型内漏率与主动脉重塑结果相当,烟囱重建法随访时的左上肢无力、头晕发生率更低。Objective To compare the therapeutic effects of chimney technique for reconstruction and simple occlusion of left subclavian artery(LSA)in the endovascular treatment of aortic dissection with insufficient proximal anchorage zone.Methods A total of 56 patients with aortic dissection with insufficient proximal anchorage zone treated with thoracic endovascular aortic repair(TEVAR)in Heze Municipal Hospital from January 2016 to March 2019 were studied retrospectively.According to the different treatments for LSA,the patients were divided into simple occlusion group(occlusion group,n=30)and chimney technique reconstruction group(reconstruction group,n=26).LSA was reconstructed with chimney technique after being occluded by aortic stent graft in reconstruction group,and LSA was only occluded by the stent graft without reconstructing in occlusion group.The related indexes of operation and postoperative follow-up for 12 months were compared between two groups.Results Compared with reconstruction group,the rates of proximal typeⅠendoleak after aortic stent release and after balloon dilatation decreased significantly in occlusion group(P<0.05).The incidence of proximal typeⅠendoleak was similar in two groups during the follow-up period,and there were no significant differences in the complete thrombosis rate of the thoracic aortic false lumen and in the results of postoperative true lumen and false lumen remodeling.The higher incidences left upper limb weakness and dizziness in occlusion group compared with reconstruction group(P<0.05).Conclusion In the treatment of aortic dissection with insufficient anchorage area,both simple occlusion and chimney technique reconstruction with occlusion for LSA have the same proximal typeⅠendoleak rate and aortic remodeling outcome.Chimney reconstruction with occlusion has lower incidences of left upper limb weakness and dizziness during follow-up period.

关 键 词：主动脉夹层 腔内修复术 烟囱技术 锁骨下动脉 支架 

分 类 号：R654.3[医药卫生—外科学]