新型国产远段打孔覆膜支架治疗Stanford B型主动脉夹层的安全性和有效性  

Safety and efficacy of a new domestic distal perforated stent graft in the treatment of Stanford type B aortic dissection

作　　者：季文凯 唐夏 陈宦君[1] 杨瑛[1] 纪敏[1] 王冀峰 朱恩帅 张丽琼[2] 王家平[3] 刘训强[1] Ji Wenkai;Tang Xia;Chen Huanjun;Yang Ying;Ji Min;Wang Jifeng;Zhu Enshuai;Zhang Liqiong;Wang Jiaping;Liu Xunqiang(Department of Vascular Surgery,Yan′an Hospital Affiliated to Kunming Medical University,Kunming 650051,China;Department of Ultrasound,Yan′an Hospital Affiliated to Kunming Medical University,Kunming 650051,China;Department of Interventional Medicine,the Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China)

机构地区：[1]昆明医科大学附属延安医院血管外科,昆明650051 [2]昆明医科大学附属延安医院超声科,昆明650051 [3]昆明医科大学第二附属医院介入科,昆明650101

出　　处：《中华医学杂志》2022年第40期3207-3212,共6页National Medical Journal of China

基　　金：云南省科技厅-昆明医科大学应用基础研究面上项目(2017FE468(-090));昆明市卫生科技人才培养项目百工程培养计划(2021-SW(省)-03)。

摘　　要：目的评估新型国产远段打孔覆膜支架(Talos支架)治疗Stanford B型主动脉夹层(TBAD)的安全性和有效性。方法选取2018年2月至2019年12月在昆明医科大学附属延安医院使用Talos支架治疗的25例TBAD患者为研究对象。术中血管造影确定释放支架后保留的分支动脉数;术后第5天通过视觉模拟评分法(VAS)评估患者疼痛情况;比较患者术前和术后6、12个月CT血管造影(CTA)气管分叉水平主动脉直径、真腔直径、假腔直径;在术后1、6、12、24个月进行随访,记录支架相关不良事件发生情况、再次手术情况及存活率。结果纳入患者男19例,女6例,年龄(52.6±11.1)岁。术中血管造影显示保留了4(1,7)条分支动脉,术后第5天VAS评分为1(0,1)分。术前和术后6、12个月气管分叉水平主动脉直径分别为(34.9±1.1)、(34.6±0.9)、(34.8±1.0)mm,差异无统计学意义(P=0.926);术前和术后6、12个月气管分叉水平真腔直径分别为(13.3±1.6)、(21.8±1.0)、(22.3±1.1)mm,术前和术后6、12个月气管分叉水平假腔直径分别为(20.8±2.2)、(4.5±1.5)、(4.6±1.7)mm,术后6、12个月真腔直径和假腔直径与术前比较差异均有统计学意义(均P<0.001)。术后30 d未发生支架相关不良事件;术后12个月未发生二次手术,未发生Ⅰ型和Ⅲ型内漏,无死亡病例与截瘫病例,支架结构、位置保持良好;术后24个月无死亡与截瘫病例,未发生支架相关不良事件。结论使用Talos支架治疗TBAD能够有效帮助主动脉重塑,同时能够保留肋间动脉与脊髓动脉,具有较好的临床效果和安全性。Objective To evaluate the safety and efficacy of a new domestic distal perforated stent graft(Talos stent)in the treatment of Stanford type B aortic dissection(TBAD).Methods Twenty-five patients with TBAD treated with Talos stent in Yan′an Hospital Affiliated to Kunming Medical University from February 2018 to December 2019 were selected as the research subjects.Intraoperative angiography was performed to determine the number of branch arteries that remained after stent release.On postoperative day 5(POD5),the pain intensity of the patients was evaluated by visual analog scale(VAS).The computed tomography angiography(CTA)of the patients before operation,6 months and 12 months after operation were compared including aortic diameter,true lumen diameter,and false lumen diameter at the level of tracheal bifurcation.Follow-up was performed 1 month,6 months,12 months,and 24 months after surgery,and the occurrence of stent-related adverse events,reoperation and survival rate were recorded.Results The enrolled patients included 19 males and 6 females,aged(52.6±11.1)years.Intraoperative angiography showed that 4(1,7)branch arteries were preserved,and the VAS score was 1(0,1)on POD5.The aortic diameters at the level of the tracheal bifurcation were(34.9±1.1)mm,(34.6±0.9)mm and(34.8±1.0)mm before surgery,6 months and 12 months after surgery,and there was no significant difference(P=0.926);the diameters of the main true lumen at the level of the tracheal bifurcation were(13.3±1.6)mm,(21.8±1.0)mm and(22.3±1.1)mm before surgery,6 months and 12 months postoperatively,while the diameters of the main false lumen at the level of the tracheal bifurcation were(20.8±2.2)mm,(4.5±1.5)mm,and(4.6±1.7)mm,respectively.Compared with before surgery,the diameter of true lumen increased significantly 6 months and 12 months after surgery(both P<0.001),while the diameter of false lumen decreased(both P<0.001).No stent-related adverse events occurred within 30 days after surgery,no secondary operations occurred within 12 months after

关 键 词：动脉瘤 夹层 覆膜支架 介入治疗 治疗结果 

分 类 号：R654.3[医药卫生—外科学]