胸主动脉腔内修复体外开窗与选择性隔绝左锁骨下动脉的前瞻性队列研究  

Prospective cohort study of thoracic endovascular aortic repair with invitro fenestration and selective exclusion of the left subclavian artery

作　　者：刘华[1] 张军[1] 林称意[1] 罗玲[1] 刘斌[2] 郭家龙[1] 罗卫民[1] 程栋梁[1] 刘涛[1] 张群献[1] LIU Hua;ZHANG Jun;LIN Cheng-yi;LUO Ling;LIU Bin;GUO Jia-long;LUO Wei-min;CHENG Dong-liang;LIU Tao;ZHANG Qun-xian(Department of cardiac and vascular surgery,Taihe Hospital(Affiliated Taihe Hospital of Hubei University of Medicine),Shiyan 442000,Hubei,China;Department of Neurology,Tongji Hospital,Tongji Medical College,Hua zhong Unibersity of Science and Technology,Wuhan 430000,China)

机构地区：[1]十堰市太和医院(湖北医药学院附属太和医院)心脏大血管外科,湖北省十堰市442000 [2]华中科技大学同济医学院附属同济医院神经内科

出　　处：《中国心血管病研究》2021年第5期385-391,共7页Chinese Journal of Cardiovascular Research

基　　金：2019湖北省卫生健康委科研立项项目(WJ2019F062);2019十堰市太和医院科研立项项目(2019JJXM012)。

摘　　要：目的探讨胸主动脉腔内修复(TEVAR)体外开窗与选择性隔绝左锁骨下动脉(LSA)的安全性和有效性。方法前瞻性队列研究分析2012年9月至2017年10月十堰市太和医院心脏大血管外科收治的117例胸主动脉病变患者的临床资料,根据左锁骨下动脉处理方式不同分为直接选择性隔绝LSA腔内修复组(endovascular exclusion,EE)和体外开窗LSA腔内修复组(invitro fenestration,IF),比较两组患者的治疗效果和3年随访结果。结果围术期期间,EE组手术时间(62.0±5.4)min,短于IF组,脑梗塞、左上肢缺血发生率分别为7.14%(4/56)、10.71%(6/56),高于IF组,差异有统计学意义(P均<0.05);EE组的内漏、脊髓缺血、术后30天病死和支架覆盖T10发生率分别为5.36%(3/56)、5.36%(3/56)、1.79%(1/56)和12.50%(7/56)与IF组相比,差异无统计学意义(P均>0.05)。随访结果方面,生存出院患者116例,失访12例,持续随访104例,随访率89.7%(104/116)。随访时间36~60个月,平均(38.1±3.2)月。3年随访结果显示EE组未增加主动脉源性死亡,但脑梗塞和上肢缺血发生率高于IF组。EE组和IF组随访3年累计生存率分别为82.23%和85.19%。两组间3年生存曲线总体比较差异无统计学意义(χ~2=0.055,P=0.814)。结论选择性隔绝左锁骨下动脉腔内修复可缩短手术时间,有效延长锚定区,降低内漏发生,但增加脑梗塞、脊髓缺血和左上肢缺血发生风险,体外开窗重建左锁骨下动脉腔内修复手术并发症低。两组中期随访结果满意,远期尚需进一步评估。Objective To investigate the safety and effectiveness of thoracic endovascular aortic repair(TEVAR)with invitro fenestration and selective exclusion of the left subclavian artery.Methods A prospective cohort analysis of the data of 117 cases of thoracic aortic lesions treated in the cardiac vascular surgical department of Shiyan Taihe hospital was made between September 2012 and October 2017.According to the left subclavian artery treating way,the patients were divided into direct selective isolation LSA endovascular aortic repair group(endovascular exclusion,EE)and invitro fenestration LSA endovascular aortic repair group(invitro fenestration,IF).The curative effect of two groups and 3 years follow-up result were compared.Results In the perioperative period,the operative time of group EE were(62.0±5.4)minutes which was shorter than that of group IF.The incidence of cerebral infarction and left upper limb ischemia were 7.14%(4/56)and 10.71%(6/56)which were higher than that of group IF,with statistical significance(P<0.05).In the group EE,the incidence of internal leakage,spinal cord ischemia,death 30 days after surgery,and stent coverage of T10 were 5.36%(3/56),5.36%(3/56),1.79%(1/56),12.50%(7/56),respectively.The differences were not statistically significant(P>0.05)compared with the group IF.In terms of follow-up results,116 patients were discharged from hospital;12 cases of them were lost to follow-up and the rest were followed up continuously,with a follow-up rate of 89.7%(104/116).The follow-up time was 36-60 months,with an average of(38.1±3.2)months.The 3-year follow-up showed no increase in aortic death,but the incidence of cerebral infarction and upper limb ischemia were higher in the group EE than in the group IF.The 3-year cumulative survival rates in the group EE and IF were 82.23%and 85.19%,respectively.There was no significant difference in the 3-year survival curve between the two groups(χ~2=0.055,P=0.814).Conclusion Selective isolation from the LSA endovascular aortic repair could shorten the op

关 键 词：胸主动脉 腔内修复 体外开窗 左锁骨下动脉 

分 类 号：R654.3[医药卫生—外科学]