自显影体外开窗、烟囱与Ⅳb型杂交技术在胸主动脉腔内修复术中重建左锁骨下动脉效果的对比研究  

Comparison of self-radiopaque markers guiding physician-modified fenestration,chimney technique and hybrid Ⅳb technique on reconstruction of left subclavian artery in thoracic endovascular aortic repair

作　　者：翟浠烨 舒畅[1,2,3] 张译丹 范博文 韩辉 田川 方坤[1] 罗明尧[1,3,4] Zhai Xiye;Shu Chang;Zhang Yidan;Fan Bowen;Han Hui;Tian Chuan;Fang Kun;Luo Mingyao(Center of Vascular Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,State Key Laboratory of Cardiovascular Disease,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Vascular Surgery,the Second Xiangya Hospital of Central South University,Changsha 410011,China;Department of Vascular Surgery,Central-China Subcenter of National Center for Cardiovascular Diseases,Henan Cardiovascular Disease Center,Fuwai Central-China Cardiovascular Hospital,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou 450046,China;Department of Vascular Surgery,Fuwai Yunnan Cardiovascular Hospital,Kunming 650102,China)

机构地区：[1]中国医学科学院北京协和医学院阜外医院血管外科中心、国家心血管病中心、心血管疾病国家重点实验室,北京100037 [2]中南大学湘雅二医院血管外科,长沙410011 [3]阜外华中心血管病医院血管外科,郑州450046 [4]云南阜外心血管病医院血管外科,昆明650102

出　　处：《中华普通外科杂志》2024年第9期662-666,共5页Chinese Journal of General Surgery

基　　金：中央高水平医院临床科研业务费(2022-GSP-GG-16,2023-GSP-RC-13);云南省科技厅重点研发计划(202403AC100004)。

摘　　要：目的对比自显影体外开窗、烟囱与Ⅳb型杂交技术在胸主动脉腔内修复术中重建左锁骨下动脉的效果。方法回顾性分析中国医学科学院阜外医院2016年1月至2019年12月312例行胸主动脉腔内修复术并重建左锁骨下动脉血供患者的临床及随访资料。结果35例为Ⅳb型杂交血管搭桥组,93例为烟囱组,184例为体外开窗组。随访时间12~24个月。所有患者随访期间均未出现人工血管及支架闭塞,左锁骨下动脉血流通畅。19例患者在末次随访时存在内漏,三组间差异无统计学意义(P>0.05)。11例患者进行了再干预手术治疗,均为烟囱组及体外开窗组患者,但差异无统计学意义(P>0.05)。住院期间,28例患者出现并发症,其中搭桥组院内并发症发生率最高(P<0.01)。随访期间,搭桥组患者4例死亡,体外开窗组6例患者死亡,烟囱组8例患者死亡,差异无统计学意义(P>0.05)。结论体外开窗和烟囱技术重建左锁骨下动脉血流的安全性和疗效相似,对于左锁骨下动脉的血流重建效果确切,早期并发症低于Ⅳb型杂交技术,但内漏再干预率高。Objective To compare the effect of self-radiopaque markers guiding physician-modified fenestration,chimney technique and hybrid Ⅳb technique on reconstruction of left subclavian artery(LSA)in endovascular treatment of aortic dissection(TEVAR).Methods The clinical and follow-up data of 312 TEVAR patients treated with LSA blood supply reconstruction technology from Jan 2016 to Dec 2019 at Fuwai hospital were retrospectively analyzed.Results There were 35 patients in the hybrid Ⅳb technique group,93 in the chimney technique group,and 184 in the in vitro fenestration group.The follow-up period ranged from 12 to 24 months.No artificial blood vessel and stent occlusion occurred in all patients during follow-up,and the LSA blood flow was unobstructed.A total of 19 patients had endoleak by the last follow-up,and there was no statistical difference between the three groups.Eleven patients underwent reintervention surgery,all were from chimney technique group and in vitro fenestration group,with no statistical difference(P>0.05).Severe complications occurred in 28 patients during hospitalization,and the incidence of complications was the highest in the hybrid Ⅳb technique group(P<0.01).During follow-up,4 patients died in the bypass group,6 died in the external window group,and 8 died in the chimney group,with no significant difference(P>0.05).Conclusions The safety and efficacy of the left subclavian artery flow reconstruction by in vitro fenestration and chimney technique were similar.The occurrences of early complications were lower than that of the hybrid Ⅳb technique,but the reintervention rate of endoleak was higher.

关 键 词：主动脉疾病 支架 自显影体外开窗 烟囱支架 Ⅳb型杂交 左锁骨下动脉 

分 类 号：R654.3[医药卫生—外科学]