不同主动脉弓上分支重建对胸主动脉腔内修复术后疗效分析  

Analysis of the effect of different supra-arch branch reconstruction after thoracic endovascular aortic repair

作　　者：焦元勇[1] 邹君杰[1] 缪苏宇[1] 杨宏宇[1] 章希炜[1] Jiao Yuanyong;Zou Junjie;Miu Suyu;Yang Hongyu;Zhang Xiwei(Department of Vascular Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,Jiangsu,China)

机构地区：[1]南京医科大学第一附属医院血管外科,江苏南京210029

出　　处：《血管与腔内血管外科杂志》2021年第7期778-782,786,共6页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨不同主动脉弓上分支重建对胸主动脉腔内修复术(TEVAR)后疗效。方法收集2009年1月至2019年12月南京医科大学第一附属医院行TEVAR治疗138例患者临床资料。根据行TEVAR手术前或同期采用不同弓上分支重建技术进行分组,分为杂交组(n=32)、单分支组(n=13)、烟囱组(n=62)和开窗组(n=31)。统计并比较四组患者临床特征和围手术期结果。TEVAR后进行随访,随访时间3个月至11年,随访内漏情况、分支狭窄情况、分支闭塞情况;统计随访期间死亡情况和术后再干预情况。结果四组患者累及无名动脉发生率比较,差异有统计学意义(P<0.05)。138例患者手术技术成功率为100%。手术时间和术后住院时间最长为杂交组患者,造影剂用量最多为开窗组患者(P<0.05);四组患者随访时间、内漏发生率比较,差异有统计学意义(P<0.05)。结论主动脉弓上分支重建方法均安全有效,但各技术间都存在各自的不足,新技术仍需大量病例积累和长期随访数据获得。Objective To investigate the effect of different supra-arch branch reconstruction after thoracic endovascular aortic repair(TEVAR).Method The clinical data of 138 patients who underwent TEVAR treatment in the First Affiliated Hospital of Nanjing Medical University from January 2009 to December 2019 were collected.According to the different supra-arch branch reconstruction techniques used before or during the TEVAR operation,they were divided into the hybrid group(n=32),single branch group(n=13),chimney group(n=62),and fenestration group(n=31).The clinical characteristics and perioperative results of the four groups of patients were counted and compared.Followup was conducted after TEVAR,and the follow-up duration was 3 months to 11 years.Endo-leak,branch stenosis,and branch occlusion were the major points.Deaths during the follow-up period and postoperative re-intervention were also counted.Result There was a statistically significant difference in the incidence of innominate artery involving the four groups of patients(P<0.05).The surgical technique success rate of 138 patients was 100%.The longest operation time and postoperative hospital stay were patients in the hybrid group,and patients in the fenestration group used the largest amount of contrast agent(P<0.05).There were statistically significant differences in the follow-up time and the incidence of endo-leak among the four groups of patients(P<0.05).Conclusion Varying supra-arch branch reconstruction interventions are safe and effective.However,they all have shortcomings in clinical practice.The new technique still requires a large number of cases and a long-term follow-up.

关 键 词：主动脉弓部疾病 胸主动脉腔内修复术 杂交技术 烟囱技术 单分支支架 开窗技术 

分 类 号：R543[医药卫生—心血管疾病]