3D打印血管外支架植入对胡桃夹综合征患者大血管血流动力学的影响  

Effect of 3D printing extravascular stent implantation on hemodynamics of large vessels in patients with nutcracker syndrome

作　　者：杜京奚 王臻 袁鸣 梁嘉赫 张波 袁丽君 杨勇 Du Jingxi;Wang Zhen;Yuan Ming;Liang Jiahe;Zhang Bo;Yuan Lijun;Yang Yong(Department of Ultrasound Medicine,Tangdu Hospital,Air Force Military Medical University,Xi'an 710038,China;Department of Medical Imaging,96608 Hospital of PLA,Hanzhong 723100,China;Department of 3D Printing Research Center,Tangdu Hospital,Air Force Military Medical University,Xi'an 710038,China;Department of Urology,Tangdu Hospital,Air Force Military Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学唐都医院超声医学科,西安710038 [2]中国人民解放军96608部队医院医学影像科,汉中723100 [3]空军军医大学唐都医院3D打印实验研究中心,西安710038 [4]空军军医大学唐都医院泌尿外科,西安710038

出　　处：《中华超声影像学杂志》2025年第1期39-45,共7页Chinese Journal of Ultrasonography

基　　金：陕西省重点研发计划项目(2023-YBSF-113);空军军医大学临床研究项目(2022LC2234)。

摘　　要：目的探究经腹腔镜3D打印血管外支架植入术对胡桃夹综合征(NCS)患者相关大血管血流动力学的影响,探讨新术式的临床安全性。方法前瞻性连续纳入2023年5-12月在空军军医大学唐都医院住院并接受经腹腔镜3D打印血管外支架植入术治疗的NCS患者30例。观察血管外支架植入术后患者腰腹痛、血尿、蛋白尿、精索静脉曲张是否好转;分别于术前1 d、术后第8 d利用超声测量左肾静脉、腹主动脉、肠系膜上动脉的内径和血流速度及下腔静脉的血流速度;采用一种新开发的基于超声多普勒技术的动脉僵硬度检测方法,分别在受检者右侧颈总动脉、股总动脉记录超声多普勒频谱,并基于此自动计算颈‒股脉搏波传播速度(cfPWV)。比较手术前后相关大血管内径、血流速度及cfPWV的差异。结果30例患者中,术后左肾静脉受压处血流速度较术前显著减低[(50.7±14.8)cm/s比(122.1±24.1)cm/s,P<0.001],患者腰腹痛、血尿、蛋白尿、精索静脉曲张较术前明显好转(均P<0.01)。手术前后腹主动脉、肠系膜上动脉的内径和血流速度、下腔静脉的血液速度及cfPWV差异无统计学意义(均P>0.05)。结论腹腔镜3D打印血管外支架植入术可有效改善NCS患者左肾静脉受压情况,且不会引起大动脉血流动力学的明显变化,提示该手术方法是一种安全可靠的NCS治疗技术。ObjectiveTo explore the effect of 3D printing extravascular stent implantation on the hemodynamics of the relevant large vessels in patients with nutcracker syndrome(NCS),and to discuss the clinical safety of this new procedure.MethodsA total of 30 NCS patients admitted to Tangdu Hospital Affiliated to Air Force Military Medical University from May to December 2023 were prospectively included.All the patients were received laparoscopic 3D printing extravascular stent implantation for NCS treatment.Whether the lumbago,abdominal pain,hematuria,proteinuria and varicocele had improved after the stent implantation were observed.The inner diameter,blood flow velocity of left renal vein,abdominal aorta,superior mesenteric artery and the diameter of inferior vena cava were measured by ultrasound 1 day before surgery and 8 days after surgery,respectively.In addition,the carotid-femoral pulse wave velocity(cfPWV)was measured by a newly developed method,by which the arterial stiffness could be detected based on Doppler ultrasound.The blood flow Doppler spectra of each subject were recorded at the right common carotid artery and the right common femoral artery,respectively,then based on that,the cfPWV was automatically calculated by this new technique.The above internal diameters,blood flow velocity and cfPWV were compared before and after the laparoscopic 3D printing extravascular stent implantation.ResultsAmong the 30 patients,the postoperative blood flow velocity at the left renal vein compression site was significantly lower than that before surgery[(50.7±14.8)cm/s vs(122.1±24.1)cm/s,P<0.001],and the clinical symptoms,including lumbago and abdominal pain,hematuria,proteinuria and varicocele were significantly improved(all P<0.05).There were no significant changes in the internal diameter,blood flow velocity of abdominal aorta,superior mesenteric artery and the diameter of inferior vena cava,and cfPWV before and after operation(all P>0.05).ConclusionsThe 3D printing extravascular stent implantation through laparoscope c

关 键 词：胡桃夹综合征 3D打印 血管外支架 超声多普勒 大动脉 

分 类 号：R699[医药卫生—泌尿科学]