3D打印指导下预开窗和内分支技术应用于弓上三分支重建及其疗效分析  

Reconstruction of triple-branched aortic arch guided by three-dimensional technique and its curative effect analysis

作　　者：刘昭[1] 付东生 金怡 赵子赫 李文东 刘晨[1] 童垣皓 张明[1] 乔彤[1] 刘长建[1] 李晓强 Liu Zhao;Fu Dongsheng;Jin Yi;Zhao Zihe;Li Wendong;Liu Chen;Tong Yuanhao;Zhang Ming;Qiao Tong;Liu Changjian;Li Xiaoqiang(Department of Vascular Surgery,Nanjing Drum Tower Hospital,The Affiliate Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院血管外科,南京210008

出　　处：《中华血管外科杂志》2022年第1期54-60,共7页Chinese Journal of Vascular Surgery

基　　金：江苏省重点研发计划(社会发展)(BE2019604)。

摘　　要：目的总结应用3D打印技术采取预束径支架开窗技术和内分支支架技术,完全血管腔内修复主动脉弓部病变并重建弓上三分支的经验及效果。方法回顾性分析2018年2月至2021年10月南京大学医学院附属鼓楼医院血管外科在3D打印指导下行主动脉弓上三分支重建的40例主动脉弓部病变患者的临床资料。其中主动脉弓动脉瘤13例,主动脉弓部夹层27例。根据CT制作3D打印模型导板,然后在导板的引导下,采用预束径技术、开窗支架技术、内分支技术全血管腔内方法修复病变并重建弓上三分支,术后随访。结果所有手术一期完成弓上分支重建,无中转开放手术。手术时间(5.07±1.42)h,无术中死亡病例。术后神经系统并发症1例(2.5%)。40例患者均获得随访,随访时间为(23.40±10.51)个月,随访期内逆撕A型夹层1例(2.5%)。结论应用3D打印技术指导下重建弓上三分支,为全血管腔内微创治疗方法,定位准确,术后恢复快,并发症发生率低,中短期效果安全可靠。Objective To sum up the experience and effect of total endovascular repair of aortic arch diseases and reconstruction of triple-branched aortic arch,which uses three-dimensional(3D)printing technique to guide the application of customized fenestrated/inner branched stent grafts technique.Methods From February 2018 to October 2021,13 cases of aortic arch aneurysms and 27 cases of aortic arch dissection were treated in Department of Vascular Surgery of Nanjing Drum Tower Hospital,including 31 males and 9 females.The 3D printing model was made according to CT images,and then under the guidance of the model,total endovascular repair such as customized fenestrated stent grafts,in situ fenestration,and inner branched stent grafts were used to repair lesions and reconstruct triple-branched aortic arch.All of the patients were followed up after operation.Results All operations completed the reconstruction of supra-aortic branches in one stage,and there was no conversion to open surgery.The operation time was(5.07±1.42)h,and there was no operative death.Postoperative neurological complications occurred in one case(2.5%).Forty patients were followed up,with a time of(23.40±10.51)months.During the follow-up time,retrograde type A dissection occurred in in one case(2.5%).Conclusion The reconstruction of triple-branched aortic arch under the guidance of 3D printing technology is a minimally invasive treatment method in total vascular cavity.It has the advantages of accurate positioning,rapid postoperative recovery,low incidence of complications,and safe and reliable medium-short term effects.

关 键 词：3D打印 主动脉弓 主动脉腔内修复术 

分 类 号：R654.3[医药卫生—外科学]