弓部开窗技术保留弓上分支血管的临床疗效  

Clinical effect of arch fenestration technique for preserving supra-aortic branch

作　　者：张滕[1] 王世知[1] 邱结华[1] 曾庆福[1] 章文文 徐颖奇 朱仙花[1] 刘诗琛 周为民[1] Zhang Teng;Wang Shizhi;Qiu Jiehua;Zeng Qingfu;Zhang Wenwen;Xu Yingqi;Zhu Xianhua;Liu Shichen;Zhou Weimin(Department of Vascular Surgery,the Second Affiliated Hospital of Nanchang University,Nanchang 330000,Jiangxi,China)

机构地区：[1]南昌大学第二附属医院血管外科,江西南昌330000

出　　处：《血管与腔内血管外科杂志》2021年第7期831-835,839,共6页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨弓部开窗技术保留弓上分支血管的临床疗效。方法选取2015年10月至2021年3月南昌大学第二附属医院收治的215例累及主动脉弓部的胸主动脉夹层及主动脉瘤患者,患者均采用弓部开窗技术进行治疗,其中,采用机械原位开窗技术治疗患者198例,采用体外预开窗技术治疗患者17例。分析弓部开窗技术对患者的临床疗效及围手术期并发症发生情况。结果实行机械原位开窗手术的技术成功率93.94%(186/198)。实行体外预开窗术的技术成功率为100%(17/17)。全部患者中,围手术期主要并发症包括入路血管损伤6例,出血2例,内漏10例,脑梗死3例,逆向撕裂2例。死亡患者2例。1例患者于术后2个月发生升主动脉逆向撕裂,1例患者发生分支支架闭塞,4例患者出现内漏,2例患者经弹簧圈栓塞后治愈,2例患者的内漏自行消失。其余患者无支架移位或变形,分支支架通畅。结论胸主动脉夹层或动脉瘤累及主动脉弓部时,机械原位开窗技术和体外预开窗技术可保留和重建弓上分支血管,具有费用低、成功率高、并发症少、近中期效果良好的优势,具有较好的临床应用价值。Objective To investigate the clinical effect of arch fenestration technique for preserving supra-aortic branch.Method From October 2015 to March 2021,215 patients of aortic dissection and aortic aneurysm involving aortic arch diseases treated by arch fenestration technique were selected from the Second Affiliated Hospital of Nanchang University,198 cases by mechanical fenestration in situ technique,17 cases by pre-fenestration in vitro technique.The clinical effect of arch fenestration technique on patients and the incidence of perioperative complications were analyzed.Result The technical success rate of mechanical fenestration in situ technique was 93.94%(186/198),while the technical success rate of pre-fenestration in vitro technique was 100%(17/17).Among all patients,the main perioperative complications included vascular injury in 6 cases,bleeding in 2 cases,internal leakage in 10 cases,cerebral infarction in 3 cases and reverse avulsion in 2 cases.Two patients died.Reverse avulsion of ascending aorta occurred in 1 patient 2 months after operation,branch stent occlusion occurred in 1 patient,internal leakage occurred in 4 patients,2 patients were cured after coil embolization,and the internal leakage disappeared in 2 patients.Other patients had no stent displacement or deformation,and the branch stent was unobstructed.Conclusion When thoracic aortic dissection or aneurysm involves the aortic arch,mechanical fenestration in situ technique and pre-fenestration in vitro technique can be used to retain and reconstruct the supra-aortic branch,which has the advantages of low cost,higher success rate,fewer complications and good effect in the medium and short term,and has higher application value in clinical practice.

关 键 词：弓上分支 主动脉夹层 胸主动脉瘤 胸主动脉腔内修复术 开窗技术 

分 类 号：R543[医药卫生—心血管疾病]