开窗-分支胸主动脉腔内修复术治疗主动脉弓部病变术后并发症危险因素的多中心回顾性研究  

Risk factors of postoperative complications after fenestrated/branched TEVAR for aortic arch lesions:a multicenter retrospective analysis

作　　者：韩月雪 刘昭[1] 刘晨[1] 李文东 胡楠 胡健航 周雨 段剑锋 孙莉莉 于浩 苏奕明 华正东[4] 陈志丹[5] 化召辉[6] 李晓强 Han Yuexue;Liu Zhao;Liu Chen;Li Wendong;Hu Nan;Hu Jianhang;Zhou Yu;Duan Jianfeng;Sun Lili;Yu Hao;Su Yiming;Hua Zhengdong;Chen Zhidan;Hua Zhaohui;Li Xiaoqiang(Department of Vascular Surgery,Drum Tower Hospital,Nanjing University School of Medicine,Nanjing 210008,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 430022,China;Department of Vascular Surgery,Xiangyang City Center Hospital,Xiangfan 441021,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]南部战区总医院心血管外科,广州510010 [3]柳州市工人医院血管外科,柳州545005 [4]武汉亚洲心脏病医院心脏中心,武汉430022 [5]襄阳市中心医院血管外科,襄阳441021 [6]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9期667-672,共6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：目的总结开窗-分支胸主动脉腔内修复术(F/B-TEVAR)治疗复杂主动脉弓疾病患者并发症的危险因素。方法回顾性分析2019年2月至2023年9月多中心接受F/B-TEVAR修复主动脉弓部病变的202例患者的临床及随访资料。结果202例患者术后出现并发症46例(22.8%)。分析显示风险因素包括:主动脉粥样硬化斑块[OR=2.843;95%CI(1.4~5.6);P<0.01]、主动脉壁内血栓[OR=2.358;95%CI(1.2~4.6);P=0.011]、主动脉扩张[OR=4.219;95%CI(1.6~11.3);P<0.01]、脑卒中史[OR=2.088;95%CI(1.1~4.1);P=0.032]、吸烟史[OR=2.680;95%CI(1.3~5.5);P<0.01]、手术时长[OR=1.9;95%CI(1.2~2.9);P=0.042]。3D打印辅助技术应用[OR=0.392;95%CI(0.2~0.9);P=0.048]可以降低并发症发生率。结论主动脉粥样硬化斑块、主动脉壁内血栓、主动脉扩张、脑卒中史、吸烟史、手术时长是F/B-TEVAR术后发生并发症的独立危险因素,应用3D打印技术辅助能降低并发症发生率。Objective To review the risk factors for early and medium-term complications of fenestration-branch endovascular thoracic aortic repair(F/B-TEVAR)in patients with complex aortic arch disease.Methods The clinical and follow-up data of 202 patients undergoing F/B-TEVAR treatment from Feb 2019 to Sep 2023 in these centers were retrospectively analyzed.Results There were 46 cases suffering from postoperative complications(22.8%).The risk factors with statistical significance included aortic atherosclerotic plaque[OR=2.843;95%CI(1.4-5.6);P<0.01],aortic intramural thrombosis[OR=2.358;95%CI(1.2-4.6),P=0.011],the aortic dilatation[OR=4.219;95%CI(1.6-11.3),P<0.01],the history of stroke[OR=2.088;95%CI(1.1-4.1),P=0.032],smoking history[OR=2.680;95%CI:(1.3-5.5);P<0.01],duration of surgery[OR=1.9;95%CI:(1.2-2.9);P=0.042].While the application of 3D printing assistive technology[OR=0.392;95%CI:(0.2-0.9);P=0.048]was in a negative correlation with postoperative complication.Conclusions The independent risk factors for complications after F/B-TVAR included aortic atherosclerotic plaque,aortic intramural thrombosis,the aortic dilatation,the history of stroke,smoking history,duration of surgery.The application of 3D printing technology can effectively reduce the complication rate.

关 键 词：主动脉疾病 支架 并发症 开窗-分支胸主动脉腔内修复术 

分 类 号：R654.3[医药卫生—外科学]