“下沉凹槽式体外开窗”技术在主动脉弓部病变中的应用经验  

Application of domed-shaped fenestration in the treatment of aortic arch lesions

作　　者：张金龙 苏成锴 黄浩岳[1] 沈振亚[1] Zhang Jinlong;Su Chengkai;Huang Haoyue;Shen Zhenya(Department of Cardiovascular,the First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院心血管外科,江苏苏州215000

出　　处：《中国血管外科杂志（电子版）》2021年第3期232-235,共4页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的探讨“下沉凹槽式体外开窗”(domed-shaped fenestration,DSF)技术在主动脉弓部病变腔内治疗的初步临床应用经验。方法回顾性分析苏州大学附属第一医院2017年1~12月收治的10例采用DSF技术保留弓上分支血管的主动脉弓部病变患者,其中缺乏锚定区的Stanford B型主动脉夹层8例,降主动脉溃疡1例,弓部动脉瘤1例。观察DSF技术的成功率、血管通畅率、内漏发生率和近期临床效果。结果患者均顺利完成DSF技术,分支血管均“超选”成功,技术成功率100%。患者弓上分支血管均显影通畅,血管通畅率100%。术后1例患者发生Ⅱ型内漏,内漏量少而继续观察。患者术后随访1年,1例患者因脑出血死亡,与手术无相关性。无脊髓缺血和神经系统并发症发生。结论DSF技术治疗缺乏锚定区的主动脉弓部病变能保留弓部分支血管,拓宽了精准释放的范围,手术成功率较高,近期效果满意。Objective To explore the clinical application of the domed-shaped fenestration(DSF)in the endovascular surgery of aortic arch lesions.Methods The clinical data of 10 patients with aortic arch lesions in the First Affiliated Hospital of Soochow University from January to December 2017 who used DSF to preserve the branches of aortic arch were analyzed retrospectively.There were 8 cases of Stanford type B aortic dissection with insufficient anchorage zone,1 case of descending aortic ulcer and 1 case of aortic arch aneurysm.Success rate of DSF,vascular patency rate,endoleak incidence and recent clinical effects were observed.Results All patients successfully completed the DSF,the branch vessels were all super-selective successfully,and the technical success rate was 100%.The branches of aortic arch were all unobstructed,and the blood vessel patency rate was 100%.TypeⅡendoleak occurred in one patient after operation.The amount of endoleak was small and patient continued to observation.Patients were followed up for one year.One patient died of cerebral hemorrhage,which was not related to the operation.No spinal cord ischemia and nervous system complications occurred.Conclusion DSF in the treatment of aortic arch lesions with insufficient anchorage zone can retain the branches of aortic arch,broaden the range of precise release.Its success rate is high,and the short-term results are satisfactory.

关 键 词：主动脉疾病 胸主动脉 支架 腔内修复术 

分 类 号：R654.3[医药卫生—外科学]