复杂型胸降主动脉病变腔内修复术时重建锁骨下动脉的研究  

Therapeutic effects of reconstruction of subclavian artery by endovascular repair in treatment of complicated descending thoracic aortic disease

作　　者：刘亚军[1] 王迪[2] 李小伟 周天宝 赵达 张伏生[1] LIU Yajun;WANG Di;LI Xiaowei(Department of Cardiovascular Surgery,The First Hospital of Qinhuangdao City,Hebei,Qinhuangdao 066000,China;不详)

机构地区：[1]河北省秦皇岛市第一医院心血管外科,066000 [2]河北省秦皇岛市第一医院内分泌科,066000

出　　处：《河北医药》2021年第17期2621-2624,共4页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题计划(编号:20191375)。

摘　　要：目的通过分析复杂型胸降部主动脉病变行腔内修复术对锁骨下动脉重建疗效的分析,总结此类病变重建锁骨下动脉血流的治疗策略。方法选择2009年6月至2021年1月收治的233例患者,分为A组(单纯完全覆盖LSA)和B组(保留LSA血流)。比较2组手术结果,并比较B组内锁骨下动脉采取不同处理方式的患者资料和治疗,分析此类病变是否重建及如何选择更高效的重建方案。结果A组与B组后缺血相关并发症为17.86%和1.95%(χ^(2)=10.50,P<0.05);3组分支支架与开窗技术、烟囱技术、杂交手术方式的成功率分别为100%/85.0%、100%/87.5%、100%/98.0%(χ^(2)=4.08,P<0.05;χ^(2)=3.93,P<0.05;χ^(2)=0.41,P>0.05)。结论主动脉腔内修复术(TEVAR)术覆盖锁骨下动脉有一定的风险,选择性或部分覆盖更为合理,高危患者尤其应重建血运,而采用分支式支架方式相对更安全、可靠。Objective To investigate the therapeutic effects of reconstruction of subclavian artery by endovascular repair in treatment of complicated descending thoracic aortic disease,and to explore corresponding treatment strategy.Methods A total of 233 patients with complicated descending thoracic aortic disease who were treated in our hospital from June 2009 to January 2021 were enrolled in the study,who were divided into group A(covering subclavian artery)and group B(keeping subclavian artery open)under endovascular therapy.The surgical results were observed and compared between the two groups,so as to find more efficient reconstruction scheme.Results There was significant difference in the incidence rate of postperative complications between group A and group B(17.86%vs 1.95%,P<0.05).The success rates of branching stent,windowing technique,chimney technique and hybrid surgical method in group A and group B were 100%vs 85.0%(P<0.05),100%vs 87.5%(P<0.05),100%vs 98.0%(P>0.05).Conclusion Covering the subclavian artery by TAVAR has certain risks,and selective or partial coverage is more reasonable.The patients at high risk should be re-vascularized,while branching stent is relatively safer and more reliable.

关 键 词：主动脉夹层 腔内治疗 锁骨下动脉 血运重建 

分 类 号：R543.1[医药卫生—心血管疾病]