胸主动脉腔内修复术中应用体外开窗技术重建左锁骨下动脉的临床分析  

Clinical analysis of fenestration in vitro for reconstruction of left subclavian artery in thoracic endovascular aortic repair

作　　者：冯苏[1] 马利娜 赵浩[1] 奚海林[1] 蔡晶 刘澄 乔彤 Su Feng;Lina Ma;Hao Zhao;Hailin Xi;Jing Cai;Cheng Liu;Tong Qiao(Department of Vascular Surgery,Xuzhou Central Hospital,Xuzhou 221009,China;Department of Thoracic Surgery,Xuzhou Central Hospital,Xuzhou 221009,China;Department of Vascular Surgery,Nanjing Drum Tower Hospital,Nanjing 210000,China)

机构地区：[1]江苏省徐州市中心医院血管外科,221009 [2]江苏省徐州市中心医院胸外科,221009 [3]南京鼓楼医院血管外科,210000

出　　处：《中华解剖与临床杂志》2021年第6期653-657,共5页Chinese Journal of Anatomy and Clinics

基　　金：国家自然科学基金(81370387)。

摘　　要：目的探讨体外开窗技术在胸主动脉腔内修复术(TEVAR)中重建左锁骨下动脉(LSA)的方法和疗效。方法回顾性分析2016年1月—2018年12月南京鼓楼医院和徐州市中心医院血管外科应用体外开窗技术在TEVAR中重建LSA的67例患者的临床资料,其中男51例、女16例,年龄41~76(63±5)岁。67例中,B型主动脉夹层50例、胸主动脉瘤11例、壁间血肿4例、主动脉溃疡2例。观察患者TEVAR后的内漏发生率,主体和分支支架的位置、完整性和通畅性,以及患者手术相关死亡率。结果 67例患者中,有66例成功采用体外开窗技术重建LSA,技术成功率达98.5%;另1例因术中对位不准确转为烟囱技术重建LSA,术后均获随访(3~48个月)。术后即刻造影提示存在少量Ⅰ型内漏3例,未予处理,术后3个月复查主动脉CT血管造影(CTA))提示内漏消失;2例患者术后出现左上肢乏力,其中1例伴头晕,均在随访过程中逐渐恢复,无肢体缺血坏死。随访中所有患者分支支架及主体支架均通畅并保持着良好的完整性,无主动脉覆膜支架移位、内漏等并发症,无手术相关死亡患者。结论体外开窗技术为TEVAR中重建LSA提供了技术支持,方法简单有效,短、中期随访结果满意。Objective To explore the method and effect of reconstruction of left subclavian artery(LSA)in the thoracic endovascular aortic repair(TEVAR)with extracorporeal fenestration.Methods The clinical data of 67 patients with reconstruction of the LSA during the TEVAR by"fenestration in vitro"in the Department of Vascular Surgery of Nanjing Drum Tower Hospital and Xuzhou Central Hospital from January 2016 to December 2018 were retrospectively analyzed.The"fenestration in vitro"technique was used in 67 patients,including 51 males and 16 females,aged 41-76(63±5)years old.The cases were as follows:50 cases of type B aortic dissection,11 cases of thoracic aortic aneurysm,4 cases of intramural hematoma,and 2 cases of aortic ulcer.The mortality,incidence of internal leakage,integrity,and patency of main and branch stents were observed.Results The technique was successful in 66 of the 67 patients.One patient was converted to the chimney technique.All 67 patients were followed up for 3-48 months.Immediately after operation,three cases showed a small amount of typeⅠinternal leakage,which was not treated.CT angiography(CTA)results showed that the leakage disappeared 3 months after the operation.Two patients felt weakness of the left upper limb;one patient experienced dizziness.They recovered gradually during the follow-up period without limb ischemia and necrosis.All the stent branches were unobstructed.No complications,such as stent displacement and internal leakage,were found.No operation-related death occurred.Conclusions The technique of extracorporeal fenestration provides technical support for the reconstruction of LSA during the TEVAR.The method is simple and effective,and the short-and medium-term follow-up results are satisfactory.

关 键 词：血管成形术 胸主动脉腔内修复术 左锁骨下动脉重建术 体外开窗 

分 类 号：R654.3[医药卫生—外科学]