体外预开窗联合束径技术在复杂主动脉病变中的应用  

Application of Pre-fenestrated Stent-Graft Technique Combined with Diameter Reduced Technique in Complex Aortic Diseases

作　　者：王彦军[1] 鲍祯 WANG Yanjun;BAO Zhen(Department of Vascular Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Respiratory and Critical Illness Ward 2,Henan Chest Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院血管外科,河南郑州450000 [2]河南省胸科医院呼吸与危重症二病区,河南郑州450000

出　　处：《河南医学研究》2024年第17期3132-3136,共5页Henan Medical Research

摘　　要：目的评价体外预开窗联合束径技术在复杂主动脉病变中的应用价值。方法回顾性收集2019年12月至2022年5月郑州大学第一附属医院血管外科收治的接受体外预开窗联合束径技术腔内修复治疗的9例复杂主动脉病变患者的临床资料,其中Stanford B型主动脉夹层4例,复杂腹主动脉瘤5例。分析手术成功率、手术时间、住院时间、围手术期死亡率、随访情况。结果9例复杂主动脉病变患者中6例接受三开窗,3例接受四开窗,共重建分支动脉血管30条,植入分支支架(BSG)26条。手术成功率为100.0%(9/9),无术中死亡病例。手术时间211~440 min,平均(333.0±70.8)min。住院时间10~33 d,平均(21.8±7.6)d。1例患者在围手术期死亡,围手术期死亡率为11.11%(1/9),死因为呼吸循环衰竭。术后随访时间0.2~14.6个月,平均随访时间(6.6±5.2)个月;随访过程无患者死亡,再处理2例(25.00%),1例患者出现左肾动脉分支支架内血栓形成,予以机械抽栓并球囊扩张,1例患者右肾动脉分支支架脱入主体支架内,予以腔内技术取出并补装BSG,其余患者主动脉病变重塑良好,无不良并发症。结论体外预开窗联合束径技术腔内修复治疗复杂主动脉疾病的短中期效果满意,具有较好的安全性、可行性。Objective To evaluate the application value of pre-fenestrated stent-graft technique combined with diameter reduced technique in complex aortic diseases.Methods The clinical data of 9 patients with complex aortic diseases in the Department of Vascular Surgery of the First Affiliated Hospital of Zhengzhou University from December 2019 to May 2022 were retrospectively collected,which included 4 cases of Stanford type B aortic dissection and 5 cases of complex abdominal aortic aneurysms.The operation success rate,operation time,hospital stay,perioperative mortality follow-up were analyzed.Results In 9 patients with complex aortic lesions,6 patients were treated with triple fenestration and 3 were treated with quadruple fenestration.A total of 30 branch arteries were reconstructed and 26 branch stents(BSG)were implanted.The operative success rate was 100.0%(9/9),and no intraoperative death was reported.The operative time was 211-440 min,average operative time was(333.0±70.8)min.The length of hospitalization was 10-33 days,the average length of hospitalization was(21.8±7.6)d.One patient died during the perioperative period,the perioperative mortality rate was 11.11%(1/9),and the death was due to respiratory and circulatory failure.The follow-up time was 0.2-14.6 months,the average follow-up time was(6.6±5.2)months.No patient died during follow-up,and 2 patients(25.00%)were retreated,1 patient had left renal artery branch stent thrombosis,mechanical thrombectomy and balloon dilation were given,and right renal artery branch stent was removed into the main stent in 1 patient,and BSG was removed by endovascular technique and reinstalled.The other patients had good remodeling of aortic lesions and no adverse complications.Conclusion Pre-fenestrated stent-graft technique combined with diameter reduced technique in treatment of in complex aortic diseases has better short and medium term effect,which is safe and feasible.

关 键 词：体外预开窗技术 束径技术 复杂主动脉病变 

分 类 号：R61[医药卫生—外科学]