基于围术期相关指标及并发症发生率探讨Castor单分支支架重建LSA与直接封闭LSA在TBAD患者腔内修复术中的应用效果  

Investigate the application effect of Castor single branch stent reconstruction LSA and direct sealing LSA in TBAD patients based on perioperative related indexes and complication rate

作　　者：刘玉峰[1] 刘卫萍[1] 齐冰心 Liu Yu-feng;Liu Wei-ping;Qi Bing-xin(Department of Vascular Surgery and Endovascular Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450046,China)

机构地区：[1]郑州大学第一附属医院大血管外科与腔内血管外科,河南郑州450046

出　　处：《四川生理科学杂志》2025年第2期240-242,284,共4页

基　　金：河南省医学科技攻关联合共建项目(编号:LHGJ20211034)。

摘　　要：目的:基于围术期相关指标及并发症发生率探讨Castor单分支支架重建封闭左锁骨下动脉(Left subclavian artery,LSA)与直接封闭LSA在B型主动脉夹层(Type B aortic dissections,TBAD)患者腔内修复术中的应用效果。方法:选取2021年7月至2023年1月期间在本院进行腔内修复术的97例TBAD患者作为研究对象,采用随机数字表法分为对照组和研究组,各50例。对照组进行直接封闭LSA治疗,研究组进行Castor单分支支架重建LSA治疗。比较两组围术期指标、手术成功率、支架状况、手术前后真腔、假腔最大直径、生化指标[白细胞介素-1β(Interleukin-1β,IL-1β)、膜糖蛋白纤维蛋白原受体-1(Pibrinogen receptor,PAC-1)、D-二聚体(D-Dimer,D-D)]、并发症。结果:两组手术成功率、住院时间、出血量、手术时间均无明显差异(P>0.05);与术前相比,术后3 m两组峡部假腔、穿膈处假腔直径均明显降低,峡部真腔、穿膈处真腔直径均明显升高(P<0.05);术后,研究组近端直径明显短于对照组,支架长度明显长于对照组(P<0.05);术后,研究组血清IL-1β、PAC-1、D-D水平明显低于对照组(P<0.05);两组并发症发生率无明显差异(P>0.05)。结论:TBAD患者采用Castor单分支支架重建LSA与直接封闭LSA治疗均能改善患者临床症状,提高手术成功率,但与直接封闭LSA相比,Castor单分支支架重建LSA能降低生化指标,改善支架状况,安全性较好。Objective:To investigate the effect of Castor single branch stent reconstruction and closure of left subclavian artery(LSA)and direct closure of LSA in patients with type B aortic dissection(TBAD)endovascular repair based on perioperative indicators and complication rate.Methods:Ninety-seven patients with TBAD who underwent endoluminal repair in our hospital between July 2021 and January 2023 were selected for the study and were divided into a control group and a study group of 50 patients each using a randomized numerical table method.The control group was treated with direct closure of LSA and the study group was treated with Castor single branch stent reconstruction of LSA.The perioperative indicators,surgical success rate,stent condition,and complications were compared between the two groups,as well as the maximum diameters of the true and false lumens,and biochemical indicators[interleukin-1β(IL-1β),platelet glycoprotein fibrinogen receptor-1(PAC-1),D-dimer(D-D)]before and after surgery.Results:There was no significant difference in the surgical success rate,hospitalization time,bleeding,and operation time between the two groups(P>0.05);compared with the preoperative period,the diameter of the pseudo-lumen at the isthmus and pseudo-lumen at the diaphragm were significantly lower,and the diameters of the true lumen at the isthmus and the true lumen at the diaphragm were significantly higher in the two groups at 3 months postoperatively(P<0.05);postoperatively,the proximal diameter in the study group was significantly shorter than that of the control group,and the length of the stent was significantly longer than that of the control group(P<0.05);after operation,serum IL-1β,PAC-1,D-D levels were significantly lower in the study group than in the control group(P<0.05);there was no significant difference in the complication rate between the two groups(P>0.05).Conclusion:In TBAD patients,Castor single branch stent reconstruction of LSA and direct blocked LSA can both improve clinical symptoms and improve the s

关 键 词：主动脉夹层 腔内修复术 封闭左锁骨下动脉 Castor单分支支架重建 膜糖蛋白纤维蛋白原受体-1 

分 类 号：R654.3[医药卫生—外科学]