复杂主动脉病变通过针刺原位开窗技术重建肾动脉的临床体会  

Clinical experience of reconstructing the renal artery by needle in-situ fenestration technique for complex aortic lesions

作　　者：齐晓宇 吴婉莹 陈阁政 张珊 周鹏 李沁 杨超[1] Qi Xiaoyu;Wu Wanying;Chen Gezheng;Zhang Shan;Zhou Peng;Li Qin;Yang Chao(Department of Vascular Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院血管外科,武汉430022

出　　处：《中华血管外科杂志》2024年第3期160-165,共6页Chinese Journal of Vascular Surgery

基　　金：湖北省科技厅重点研发计划(2022BCA024)。

摘　　要：目的总结复杂主动脉病变通过针刺原位开窗(NISF)重建肾动脉的临床经验。方法本研究为回顾性纵向研究。回顾性分析2021年3月至2024年3月华中科技大学同济医学院附属协和医院血管外科应用NISF治疗6例累及内脏区的主动脉病变患者的临床资料。其中男性5例, 女性1例;主动脉夹层5例, 腹主动脉瘤1例。结果 6例均采用Futhrough主动脉覆膜支架破膜系统和Fustar可调弯鞘进行针刺开窗, 靶血管为右肾动脉4例, 左肾动脉2例;靶血管开口到内膜(或覆膜支架边缘)中点距离为(21.92±10.86)mm。NISF技术成功率100%(6/6)。术后内漏2例, 无NISF相关内漏。患者症状均缓解, 无死亡病例, 1例出现左肾囊肿破裂出血并再干预。随访时间为(84.7±48.8)d, 无死亡病例, 靶血管均通畅, 无再发主动脉夹层。结论 NISF用于重建复杂主动病变中肾动脉血供可取得良好的短期效果, 是体外预开窗的有效补充手段。Objective To summarize the clinical experience of needle in situ fenestration(NISF)technique for the reconstruction of the renal artery in complex aortic lesions.Methods This was a retrospective longitudinal study.A retrospective analysis was conducted on the clinical data of 6 patients with aortic lesions involving visceral branches treated with NISF technique in Department of Vascular Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from March 2021 to March 2024,including 5 males and 1 female,with 5 cases of aortic dissection and 1 abdominal aortic aneurysm.Results In all 6 cases,NISF was performed using the Futhrough aortic covered stent graft system and Fustar adjustable curved sheath.Four cases targeted the right renal artery and two targeted the left renal artery,with a technical success rate of 100%.The focal distance from the target vessel opening to the intima(or the edge of the covered stent)was(21.92±10.86)mm.There were 2 cases of endoleak postoperatively,but no endoleaks related to NISF occurred.All patients'symptoms were relieved,and there were no deaths.One case experienced rupture and hemorrhage of a left renal cyst requiring further intervention.Patients were followed up for(84.7±48.8)days,with no deaths,patent target vessels,and no recurrence of aortic dissection.Conclusion NISF technique for the reconstruction of the renal artery in complex aortic lesions can achieve good short-term results and can be considered as an effective complementary method to pre-fenestration.

关 键 词：肾动脉 主动脉疾病 针刺原位开窗 分支重建 

分 类 号：R654.3[医药卫生—外科学]