体外开窗技术在主动脉夹层腔内治疗中重建左锁骨下动脉血流的疗效分析  

Clinical effect of in vitro fenestration on reconstruction of left subclavian artery in endovascular treatment of aortic dissection

作　　者：李冬霖 陈卢峰[1] 李荣宾[1] 蔡旭东[1] LI Donglin;CHEN Lufeng;LI Rongbin;CAI Xudong(The Second Affiliated Hospital of Fujian Medical University,Quanzhou,362000,Fujian,P.R.China)

机构地区：[1]福建医科大学附属第二医院,福建泉州362000

出　　处：《中国胸心血管外科临床杂志》2023年第3期403-409,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨体外开窗技术在主动脉夹层腔内治疗中重建左锁骨下动脉血流的疗效。方法纳入2017年2月—2020年1月福建医科大学附属第二医院腔内治疗累及左锁骨下动脉的主动脉夹层患者89例,其中试验组利用体外开窗技术重建,44例,男36例、女8例,平均年龄(58.02±13.58)岁;对照组利用烟囱技术重建,45例,男35例、女10例,平均年龄(54.10±12.32)岁。比较两组患者的临床资料。结果试验组手术时间较对照组长[(126.16±7.53)min vs.(96.49±6.52)min,P<0.01]。中位随访时间31(13~48)个月,随访期间试验组内漏发生率(4.7%)低于对照组(18.6%),差异有统计学意义(P=0.04)。两组患者在脑卒中、心肌梗死、假腔血栓化、逆撕性主动脉夹层、左锁骨下动脉闭塞的发生率差异无统计学意义(P>0.05)。结论体外开窗技术重建左锁骨下动脉血流在主动脉夹层腔内治疗中安全可行,值得推广。Objective To investigate the effect of in vitro fenestration on reconstruction of left subclavian artery in endovascular treatment of aortic dissection.Methods A total of 89 patients with aortic dissection involving left subclavian artery were treated by endovascular treatment in the Second Affiliated Hospital of Fujian Medical University from February 2017 to January 2020.There were 44 patients in the test group,including 36 males and 8 females,with an average age of 58.02±13.58 years.There were 45 patients in the control group,including 35 males and 10 females,with an average age of 54.10±12.32 years.The left subclavian artery was reconstructed by in vitro fenestration in the test group and by chimney technique in the control group.The clinical data were compared between the two groups.Results The operation time of the test group was longer than that of the control group(126.16±7.53 min vs.96.49±6.52 min,P<0.01).The median follow-up time was 31(13-48)months.The incidence of endoleak in the test group(4.7%)was lower than that in the control group(18.6%,P=0.04)during the follow-up.There was no statistical difference in the incidence of stroke,myocardial infarction,false lumen thrombosis,retrograde aortic dissection or left subclavian artery occlusion between the two groups(P>0.05).Conclusion In vitro fenestration for reconstructing left subclavian artery in thoracic endovascular aortic repair of aortic dissection is safe and feasible,which is worthy of further clinical promotion.

关 键 词：主动脉夹层 体外开窗 烟囱技术 腔内治疗 左锁骨下动脉 

分 类 号：R654.3[医药卫生—外科学]