3D打印辅助预开窗及分支支架腔内修复术治疗胸腹主动脉瘤  

3D printing-assisted pre-fenestration and branch stent endovascular repair for the treatment of thoracoabdominal aortic aneurysms

作　　者：胡佳腾 李逢时 徐昕童 黄晟 卢化祥 秦金保[1] 叶开创[1] 刘晓兵[1] 刘光[1,2] 陆信武[1,2] Hu Jiateng;Li Fengshi;Xu Xintong;Huang Sheng;Lu Huaxiang;Qin Jinbao;Ye Kaichuang;Liu Xiaobing;Liu Guang;Lu Xinwu(Department of Vascular Surgery,Shanghai Ninth People's Hospital,Shanghai Jiaotong University school of Medicine,Shanghai 200011,China;Vascular Centre of Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院血管外科,上海200011 [2]上海交通大学医学院血管病诊治中心,上海200011

出　　处：《中华普通外科杂志》2023年第7期491-495,共5页Chinese Journal of General Surgery

基　　金：上海市卫生健康委员会临床研究专项(202240145);国家自然科学基金(81970405)。

摘　　要：目的评估3D打印辅助预开窗及分支支架腔内修复术(F/b EVAR)治疗胸腹主动脉瘤的安全性和有效性。方法回顾性分析上海交通大学医学院附属第九人民医院血管外科2019年5月至2022年9月收治的26例运用3D打印辅助F/b EVAR治疗的复杂性胸腹主动脉患者的临床资料。结果26例TAAA患者共计重建95支内脏分支动脉,技术成功率97.89%(93/95),术后平均随访时间(8.03±4.15)个月;5例术后发生Ⅲc型内漏,4例随访后消失,1例范围缩小,瘤体未扩大。1例患者发生Ⅰc型内漏,在远端增加一枚支架后内漏消失。随访期间主动脉CTA提示1例患者肾动脉支架闭塞,余内脏分支血管血流畅。随访无脏器缺血、下肢缺血等并发症和全因死亡发生。结论3D打印辅助F/b EVAR微创修复TAAA是一项可行的、有效的、安全的技术手段,内脏分支动脉重建成功率高,并发症发生率低。Objective To evaluate the safety and efficacy of 3D printing-assisted pre-fenestration and branch stent endovascular repair(F/b EVAR)in the treatment of thoracoabdominal aortic aneurysms.Methods The clinical data of 26 patients treated with 3D printing-assisted F/b EVAR for complicated thoracic and abdominal aortic diseases at the Department of Vascular Surgery,the Ninth People's Hospital,Shanghai Jiaotong University School of Medicine from May 2019 to Sep 2022 were retrospectively analyzed.Results The success rate in these 26 cases of TAAA with 3D printing combined with F/b EVAR was 97.89%,and the mean follow-up time was(8.03±4.15)months.Four cases hadⅢc internal leakage and disappeared during the follow-up.One case of typeⅢleakage were narrowed during follow-up.Ic type internal leakage occurred in 1 patient and disappeared after the addition of a stent at the distal end.During the follow-up period,aortic CTA indicated that 1 patient had renal artery stent occlusion and smooth blood in other visceral branches.No complications such as organ ischemia,lower limb ischemia and all-cause death occurred during follow-up.Conclusion 3D printing-assisted F/b EVAR minimally invasive repair of TAAA is a feasible,effective and safe technique,with high success rate and low complication rate of visceral branch artery reconstruction.

关 键 词：主动脉瘤 胸 主动脉瘤 腹 内脏动脉血运重建 3D打印 

分 类 号：R654.4[医药卫生—外科学]