3D打印指导下开窗/分支支架治疗胸腹主动脉病变:全国多中心回顾性研究  

3D print-guided fenestration/branch stent treatment of abdominal aortic disease: a national multicenter retrospective study

作　　者：韩月雪 金怡 付东生 胡健航 段剑锋 孙莉莉 王冕[2] 于浩 苏奕明 华正东[5] 陈志丹[6] 郭世奎[7] 化召辉[8] 李晓强 刘昭[1] Han Yuexue;Jin Yi;Fu Dongsheng;Hu Jianhang;Duan Jianfeng;Sun Lili;Wang Mian;Yu Hao;Su Yiming;Hua Zhengdong;Chen Zhidan;Guo Shikui;Hua Zhaohui;Li Xiaoqiang;Liu Zhao(Department of Vascular Surgery,Drum Tower Hospital,Nanjing University School of Medicine,Nanjing 210008,China;Department of Vascular Surgery,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510062,China;Department of Cardiovascular Surgery,Southern Theater General Hospital,Guangzhou 510010,China;Department of Vascular Surgery,Liuzhou Workers'Hospital,Liuzhou 545005,China;Heart Center,Wuhan Asian Heart Hospital,Wuhan 430056,China;Department of Vascular Surgery,Xiangyang City Center Hospital,Xiangyang 441021,China;Department of Vascular Surgery,Yunnan First People's Hospital,Kunming 650032,China;Department of Endoluminal Vascular Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]南京大学医学院附属鼓楼医院血管外科,南京210008 [2]中山大学附属第一医院血管外科,广州510062 [3]南部战区总医院心血管外科,广州510010 [4]柳州市工人医院血管外科,柳州545005 [5]武汉亚洲心脏病医院心脏中心,武汉430056 [6]襄阳市中心医院血管外科,襄阳441021 [7]云南省第一人民医院血管外科,昆明650032 [8]郑州大学第一附属医院腔内血管外科,郑州450052

出　　处：《中华普通外科杂志》2024年第7期527-533,共7页Chinese Journal of General Surgery

基　　金：国家自然科学基金(82370520);江苏省卓博计划(2022ZB689);南京鼓楼医院临床研究专项资金(2023-LCYJ-PY-23)。

摘　　要：目的探讨应用3D打印技术指导开窗/分支支架技术(fenestrated/branched endovascular repair,F/B-EVAR)血管腔内修复胸腹主动脉疾病的经验。方法回顾性分析2018年2月至2023年3月全国范围内69家医疗中心采用3D打印技术指导医师自制支架行F/B-EVAR修复胸腹主动脉病变共316例患者的临床及随访资料。结果本组中位随访时间23个月(2~60个月),随访丢失24例,随访率92.4%(292/316),平均术后住院时间(8.2±4.9)d,共重建胸腹主段分支动脉944条。术中11条分支动脉重建失败,成功率98.8%(933/944)。术后30 d内,死亡8例,死亡率2.5%,随访中死亡6例,共死亡14例,死亡率4.4%(14/316)。脊髓缺血11例(3.5%),无永久性截瘫。术后肾功能损伤19例(6.0%)。术后26例患者检查中发现内漏,内漏率8.2%。结论3D打印技术可对分支动脉位置个体化精准定位,同时简化手术流程,缩短学习曲线且临床疗效较佳。ObjectiveTo study the application of 3D printing technology in multi-center fenestrated/branched endovascular repair(F/B-EVAR)for endovascular repair of abdominal aortic diseases.MethodsFrom Feb 2018 to Mar 2023,The clinical and followup data of 316 cases of abdominal aortic lesions undergoing repair with F/B-EVAR at 69 medical centers nationwide using 3D printing technology to guide physician-modified stent graft were retrospectively analyzed.ResultsThe mean follow-up time of the patients was 23 months(2-60 months),and 24 cases were lost to follow up,the follow-up rate was 92.4%(292/316),the mean postoperative hospitalization time was(8.2±4.9)days.A total of 944 main abdominal branch arteries were reconstructed.Intraoperative reconstruction of 11 branches failed,with a success rate of 98.8%(933/944).Within 30 days after surgery,8 patients died(2.5%),and 6 patients died during follow-up,a total of 14 patients died(4.4%).There were 11 cases(3.5%)of spinal cord ischemia and no patient suffered from permanent paraplegia.There were 19 patients(6.0%)with postoperative renal function injury.Internal leakage was found in 26 patients,and the rate of internal leakage was 8.2%.Conclusion3D printing technology can accurately locate the location of branch arteries,simplifing the surgical process,shortening the learning curve,and improving clinical efficacy.

关 键 词：主动脉瘤 腹 主动脉瘤 胸 3D打印 开窗分支支架技术 

分 类 号：R654[医药卫生—外科学]