摘要
目的探讨应用3D打印技术指导开窗/分支支架技术(fenestrated/branched endovascular repair,F/B-EVAR)血管腔内修复胸腹主动脉疾病的经验。方法回顾性分析2018年2月至2023年3月全国范围内69家医疗中心采用3D打印技术指导医师自制支架行F/B-EVAR修复胸腹主动脉病变共316例患者的临床及随访资料。结果本组中位随访时间23个月(2~60个月),随访丢失24例,随访率92.4%(292/316),平均术后住院时间(8.2±4.9)d,共重建胸腹主段分支动脉944条。术中11条分支动脉重建失败,成功率98.8%(933/944)。术后30 d内,死亡8例,死亡率2.5%,随访中死亡6例,共死亡14例,死亡率4.4%(14/316)。脊髓缺血11例(3.5%),无永久性截瘫。术后肾功能损伤19例(6.0%)。术后26例患者检查中发现内漏,内漏率8.2%。结论3D打印技术可对分支动脉位置个体化精准定位,同时简化手术流程,缩短学习曲线且临床疗效较佳。
ObjectiveTo study the application of 3D printing technology in multi-center fenestrated/branched endovascular repair(F/B-EVAR)for endovascular repair of abdominal aortic diseases.MethodsFrom Feb 2018 to Mar 2023,The clinical and followup data of 316 cases of abdominal aortic lesions undergoing repair with F/B-EVAR at 69 medical centers nationwide using 3D printing technology to guide physician-modified stent graft were retrospectively analyzed.ResultsThe mean follow-up time of the patients was 23 months(2-60 months),and 24 cases were lost to follow up,the follow-up rate was 92.4%(292/316),the mean postoperative hospitalization time was(8.2±4.9)days.A total of 944 main abdominal branch arteries were reconstructed.Intraoperative reconstruction of 11 branches failed,with a success rate of 98.8%(933/944).Within 30 days after surgery,8 patients died(2.5%),and 6 patients died during follow-up,a total of 14 patients died(4.4%).There were 11 cases(3.5%)of spinal cord ischemia and no patient suffered from permanent paraplegia.There were 19 patients(6.0%)with postoperative renal function injury.Internal leakage was found in 26 patients,and the rate of internal leakage was 8.2%.Conclusion3D printing technology can accurately locate the location of branch arteries,simplifing the surgical process,shortening the learning curve,and improving clinical efficacy.
作者
韩月雪
金怡
付东生
胡健航
段剑锋
孙莉莉
王冕
于浩
苏奕明
华正东
陈志丹
郭世奎
化召辉
李晓强
刘昭
Han Yuexue;Jin Yi;Fu Dongsheng;Hu Jianhang;Duan Jianfeng;Sun Lili;Wang Mian;Yu Hao;Su Yiming;Hua Zhengdong;Chen Zhidan;Guo Shikui;Hua Zhaohui;Li Xiaoqiang;Liu Zhao(Department of Vascular Surgery,Drum Tower Hospital,Nanjing University School of Medicine,Nanjing 210008,China;Department of Vascular Surgery,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510062,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 430056,China;Department of Vascular Surgery,Xiangyang City Center Hospital,Xiangyang 441021,China;Department of Vascular Surgery,Yunnan First People's Hospital,Kunming 650032,China;Department of Endoluminal Vascular Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2024年第7期527-533,共7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)。
关键词
主动脉瘤
腹
主动脉瘤
胸
3D打印
开窗分支支架技术
Aortic aneurysms,abdominal
Aortic aneurysms,thoracic
3D printing
Fenestrated and branched endovascular aortic repair
