3D打印辅助开窗支架及分支支架技术治疗累及内脏动脉区胸腹主动脉瘤的效果分析  

Effectiveness of endovascular repair with fenestration stent and branch stent assisted by 3D printing in treating thoracoabdominal aortic aneurysm involving visceral artery area

作　　者：孙岩 王玉涛 张十一 董典宁 吴学君 SUN Yan;WANG Yutao;ZHANG Shiyi;DONG Dianning;WU Xuejun(Department of Vascular Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan,250021,P.R.China;Department of Peripheral Vascular Disease,Jinan Municipal Hospital of Traditional Chinese Medicine,Jinan,250012,P.R.China)

机构地区：[1]山东第一医科大学附属省立医院血管外科,济南250021 [2]济南市中医医院周围血管病科,济南250021

出　　处：《中国胸心血管外科临床杂志》2022年第1期90-94,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：山东省医药卫生科技发展计划项目(2018WS478;2018WS273);济南市第二届优秀卫生计生人才培养项目(济卫科外发[2018]8号);济南市第三批“薪火传承231工程”培养项目(济中医药发[2017]11号);济南市卫生健康系统青年岗位能手培养项目(济卫发[2019]1号)。

摘　　要：目的初步探讨在3D打印辅助下应用体外开窗及分支支架腔内修复术治疗累及内脏动脉区胸腹主动脉瘤的临床应用价值。方法回顾性分析山东第一医科大学附属省立医院血管外科2016年3月至2019年5月收治的7例累及内脏动脉区胸腹主动脉瘤患者的临床资料,其中男5例、女2例,平均年龄(70.2±3.9)岁。4例为近肾腹主动脉瘤,3例为胸主动脉瘤;4例为无症状动脉瘤,2例为急性有症状动脉瘤,1例发生动脉瘤先兆破裂。全部患者均根据术前CT测量及3D打印模型,采用Cook Zenith胸主动脉支架体外开窗,缝制分支支架,并应用束径技术改良支架后,进行腔内治疗。结果7例患者均顺利完成手术,共重建18支分支动脉,手术器械释放成功率100.0%。平均手术时间(267.0±38.5)min,平均术中出血量(361.0±87.4)mL,平均住院时间(16.0±4.2)d。术中即刻造影显示:动脉瘤隔绝确切,各内脏动脉通畅。截至2019年5月,共随访1~38个月,随访期间无患者死亡、支架移位或闭塞、动脉瘤破裂、内脏动脉分支丢失等情况发生。结论3D打印技术能够完整复制人体主动脉形态,直观呈现各分支动脉的解剖结构及位置关系,使开窗技术更加精准,治疗方案更加优化。Objective To evaluate the clinical value of in vitro fenestration and branch stent repair in the treatment of thoracoabdominal aortic aneurysm in visceral artery area assisted by 3 D printing.Methods The clinical data of 7 patients with thoracoabdominal aortic aneurysm involving visceral artery at the Department of Vascular Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University from March 2016 to May 2019 were analyzed retrospectively.There were 5 males and 2 females with an average age of 70.2±3.9 years.Among them 4 patients had near-renal abdominal aortic aneurysm,3 had thoracic aortic aneurysm,4 had asymptomatic aneurysm,2 had acute symptomatic aneurysm and 1 had threatened rupture of aneurysm.According to the preoperative CT measurement and 3D printing model,fenestration technique was used with Cook Zenith thoracic aortic stents,and branch stents were sewed on the main stents in vitro,and then the stents were modified by beam diameter technique for intracavitary treatment.Results All the 7 patients completed the operation successfully,and a total of 18 branch arteries were reconstructed.The success rate of surgical instrument release was 100.0%.The average operation time was 267.0±38.5 min,the average intraoperative blood loss was 361.0±87.4 mL and the average hospital stay was 16.0±4.2 d.Immediate intraoperative angiography showed that the aneurysms were isolated,and the visceral arteries were unobstructed.Till May 2019,there was no death,stent displacement,stent occlusion,ruptured aneurysm or loss of visceral artery branches.Conclusion 3D printing technology can completely copy the shape of human artery,intuitively present the anatomical structure and position of each branch of the artery,so that the fenestration technique is more accurate and the treatment scheme is more optimized.

关 键 词：3D打印 腔内修复术 主动脉瘤 开窗支架 分支支架 

分 类 号：R654.3[医药卫生—外科学]