3D打印辅助支架体外预开窗及束径技术治疗复杂腹主动脉病变  

3D printed template assisted pre-fenestration of stent graft with reducing-diameter tie technique for complex abdominal aortic diseases

作　　者：张文广[1] 孙占国 任建庄[1] 张萌帆 陈鹏飞[1] 杨鹏伟[2] 王保收 周朋利[1] 韩新巍[1] Zhang Wenguang;Sun Zhanguo;Ren Jianzhuang;Zhang Mengfan;Chen Pengfei;Yang Pengwei;Wang Baoshou;Zhou Pengli;Han Xinwei(Department of Cardiology,Chest Hospital of Henan Province,Zhengzhou 450007,China;Department of Cardiothoracic Surgery,Kaifeng Central Hospital,Kaifeng 475001,China;Department of Interventional Radiology,the First Affiliated Hospital of Zhengzhou University,Institute of Interventional Clinical Treatment and Research of Henan Province,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院介入科、河南省介入治疗临床与研究中心,郑州450052 [2]河南省胸科医院心血管内科,郑州450007 [3]开封市中心医院心脏大血管外科,开封475001

出　　处：《中华普通外科杂志》2023年第1期23-27,共5页Chinese Journal of General Surgery

基　　金：河南省创新型科技人才队伍建设工程专项基金(172101510002);河南省高校重点科研项目(23A320056)。

摘　　要：目的探讨3D打印引导下应用覆膜支架体外开窗、预束径技术及分支支架技术,完全腔内修复复杂腹主动脉病变并重建内脏动脉分支的疗效。方法回顾性分析2019年1月—2021年11月于郑州大学第一附属医院介入科、河南省胸科医院心内科及开封市中心医院心外科利用3D打印技术辅助腹主动脉内脏分支重建的20例复杂腹主动脉病变患者的临床资料。结果所有患者术前均利用CT数据制作3D打印模型,术中在3D模型引导下,依次主动脉支架体外开窗、预束径及内脏动脉分支支架置入行完全主动脉腔内修复术。20例患者均成功完成手术,其中单开窗2例、双开窗5例、三开窗10例、四开窗3例,无中转开放手术。术中重建内脏分支54根(右肾动脉20根、左肾动脉18根、肠系膜上动脉13根及腹腔干3根)。中位随访时间14.6个月,死亡1例,分支动脉一期通畅率98.1%;4例发生内漏。1例术后3个月脑血管意外死亡,无1例截瘫或内脏器官缺血发生。结论 3D打印辅助覆膜支架体外开窗、预束径技术及分支支架技术,可以实现内脏动脉分支重建并全腔内隔绝治疗复杂腹主动脉病变,近期疗效好。Methods From Jan 2019 to Nov 2021,20 patients underwent 3D printed template assisted pre-fenestration of stent graft with reducing-diameter tie technique and branched stents for the EVAR at the three hospitals.The clinical data patients were collected and analyzed.Results All the 20 cases underwent 3D printed template assisted pre-fenestration of stent graft according to the data of pre-operative the computed tomographic angiography(CTA).EVAR was successfully performed in all patients(included 2 cases with one fenestration,5 cases with 2 fenestration,10 cases with 3 fenestration and 3 cases with 4 fenestration).Fifty-four reinforced fenestrations(20 in right renal artery,18 in left renal artery,13 in superior mesenteric artery and 3 in celiac artery)were performed.During the follow-up period(mean 14.6 months),1 case died,and the one-stage patency rate of splanchnic artery branch stent was 98.1%.Four patients had endoleak,1 patient died of intracranial hemorrhage during postoperative period.None of patients had postoperative paraplegia or organ ischemia.Conclusions 3D printed template assisted pre-fenestration of stent graft with reducing-diameter tie technique is feasible for EVAR in the treatment of complex abdominal aortic aneurysms and dissections.The technique is capable to reinforce the blood supply of visceral arteries with satisfied short-term effectiveness.Ojective To evaluate 3D printed template assisted pre-fenestration of stent graft with reducing-diameter tie technique and branched stents for the endovascular aortic aneurysm repair(EVAR).

关 键 词：主动脉疾病 支架 治疗结果 

分 类 号：R654.2[医药卫生—外科学]