单分支支架重建与单纯封闭左锁骨下动脉术在锚定区不足的Stanford B型主动脉夹层腔内修复术中的临床疗效  

Clinical effect of single branch stent reconstruction and left subclavian artery closure in endovascular treatment of Stanford type B aortic dissection with inadequate anchoring area

作　　者：裴长安[1] 胡潍青[1] 尚遂源 汲武广[1] 孙波[1] 张纪存 曹广信[1] 刘涛[1] 姜炎杰 张杰峰[1] Pei Chang'an;Hu Weiqing;Shang Suiyuan;Ji Wuguang;Sun Bo;Zhang Jicun;Cao Guangxin;Liu Tao;Jiang Yanjie;Zhang Jiefeng(Department of Vascular Surgery,Weifang People's Hospital,Weifang 261000,Shandong,China)

机构地区：[1]潍坊市人民医院血管外科,山东潍坊261000

出　　处：《血管与腔内血管外科杂志》2023年第10期1232-1237,共6页Journal of Vascular and Endovascular Surgery

基　　金：潍坊市卫生健康委员会科研项目(WFWSJK-2020-268)。

摘　　要：目的 探讨单分支支架重建与单纯封闭左锁骨下动脉(LSA)术在锚定区不足的Stanford B型主动脉夹层(TBAD)腔内修复术中的临床疗效。方法 收集2019年1月至2021年9月于潍坊市人民医院行胸主动脉腔内修复术(TEVAR)的48例TBAD患者的临床资料,按照手术方式的不同将其分为A组(n=25,采用Castor单分支支架重建LSA)与B组(n=23,直接封闭LSA),比较两组患者的手术成功率、手术时间、出血量、住院时间、并发症、假腔血栓化、手术前后真假腔直径变化等指标。结果 两组患者术区血管测量数据比较,差异无统计学意义(P﹥0.05)。A组患者支架长度大于B组患者,支架远端直径小于B组患者,差异均有统计学意义(P﹤0.05)。A组患者手术成功率100%,与B组患者的95.6%比较,差异无统计学意义(P﹥0.05)。两组患者手术时间、出血量、住院时间、并发症发生率比较,差异均无统计学意义(P﹥0.05)。两组患者支架覆盖段假腔均完全血栓化。术前、术后3个月,两组患者主动脉真、假腔直径比较,差异均无统计学意义(P>0.05);术后3个月,两组患者主动脉峡部、穿膈处真腔直径均大于本组术前,假腔直径均小于本组术前,差异均有统计学意义(P﹤0.05)。结论 对于锚定区不足的TBAD使用Castor单分支主动脉支架重建LSA安全有效,单纯封闭LSA术可在部分患者中选择使用。Objective To evaluate the efficacy of single branch stent reconstruction and left subclavian artery(LSA)closure in Stanford type B aortic dissection(TBAD)with inadequate anchoring area.Method Clinical data of 48 TBAD patients who were treated with thoracic endovascular aortic repair(TEVAR)in Weifang People's Hospital from January 2019 to September 2021 were collected,they were divided into group A(n=25,treated with Castor single branch stent to reconstruct LSA)and group B(n=23,treat with surgery to close LSA)according to different surgical methods.The operative success rate,operative time,blood loss,length of hospital stay,complications,false lumen thrombogenesis and diameter changes of true and false lumen before and after surgery were compared between the two groups. Result There was no statistically significant difference in blood vessel measurement data between the two groups of patients at the surgical site (P>0.05). The stent length of group A was greater than that of group B, the distal diameter stent of group A was smaller than that of group B, with statistically significant differences (P<0.05). The surgical success rate of group A was 100%, and there was no statistically significant difference compared to the 95.6% rate of group B (P>0.05). There were no significant differences in operation time, blood loss, incidence of complications between the two groups (P>0.05). Both groups of patients had complete thrombosis of the false lumen covered by the stent. There was no statistically significant difference in aortic true and false lumen diameters between the two groups of patients before and 3 months after surgery (P>0.05);three months after surgery, the true lumen diameter at the aortic isthmus and diaphragmatic junction of both groups of patients were greater than those before the surgery, while the false lumen diameter were smaller than those before the surgery, with statistical significance (P<0.05). Conclusion Single-branch aortic stent reconstruction of LSA is safety and effective for TBAD with inade

关 键 词：主动脉夹层 左锁骨下动脉 腔内修复术 单分支支架 

分 类 号：R543[医药卫生—心血管疾病]