兰州大学机构库 >第二临床医学院
左锁骨下动脉4种重建技术在B型主动脉夹层腔内修复术中的应用对比研究
Alternative TitleComparative study on the application of four revascularization techniques of left subclavian artery in endovascular repair of type B aortic dissection
张朋宾
Subtype硕士
Thesis Advisor高秉仁
2021-05-25
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name医学硕士
Degree Discipline外科学
KeywordB型主动脉夹层 腔内修复技术 左锁骨下动脉 血运重建
Abstract研究目的:总结本院行左锁骨下动脉(Left subclavian artery,LSA)血运重建联合胸主动脉腔内修复术(Thoracic endovascular aortic repair,TEVAR)救治的近端锚定区不足的Stanford B型主动脉夹层(Aortic dissection,AD)患者资料。对比分析旁路技术(Hybrid technique,HT)、烟囱技术(Chimney graft,CG)、单分支支架技术(Single-branched stent graft,SBSG)和体外开窗技术(In vitro fenestration,IVF)4种LSA重建方式的疗效和安全性,为临床上此类患者LSA血运重建方式的选择提供临床依据。 研究方法:统计分析2013年03月至2020年03月,我院收治的应用TEVAR联合LSA重建救治105例B型主动脉夹层,按照LSA重建方式分为四组:HT组(41例)、CG组(29例)、SBSG组(21例)、IVF组(14例)。收集四组患者一般情况,围手术期资料和术后随访资料,运用统计学方法对以上资料进行组间比较。 结果:四种技术成功率均达到100%,四种技术在B型AD急诊手术中应用的比率具有统计学差异(P<0.05),HT组急诊手术比率最高。在术中失血量、造影剂使用量、透视时间、手术时间、总住院费用、随访期间LSA缺血症状发生率方面,四组患者具有统计学差异(P<0.05)。组间两两比较发现,HT组术中失血量和手术时间均高于其余三组(调整后P<0.0083;P<0.05),按照造影剂使用量和透视时间排序为SBSG>IVF>CG>HT组,SBSG组总住院费用明显高于其余三组(P<0.05),IVF组随访期间LSA缺血症状发生率最高,其余组间比较未见明显统计学差异。四组患者在围手术期及随访期间并发症(除LSA缺血症状)发生率的差异均无统计学差异(P>0.05),HT组、CG组、SBSG组、IVF组中位随访时间具有明显差异(P<0.05),其中HT组随访时间最长。 结论:四种LSA血运重建技术均可有效恢复LSA血流灌注,均可拓展TEVAR在Stanford B型夹层中的应用范围。SBSG技术在B型AD急诊手术中应用欠佳,但患者短期预后较好。HT、CG、IVF技术具有可比性,但HT手术时间和术中失血量均大于腔内LSA血运重建技术,IVF技术患者术后LSA通畅性较差。四种LSA重建技术各有优缺点,本研究仍需要大样本、多中心、随机对照研究进一步验证。 关键词:B型主动脉夹层,腔内修复技术,左锁骨下动脉,血运重建
Other AbstractObjective: To summarize the data of Stanford type B aortic dissection patients with insufficient proximal anchoring area treated by left subclavian artery (LSA) revascularization combined with Thoracic endovascular aortic repair (TEVAR) in our hospital. Comparative analysis on the effectiveness and safety of the Hybrid technique (HT), chimney graft (CG), single-branched stent graft (SBSG) and In vitro fenestration (IVF) methods was made, so as to provide clinical basis for the selection of LSA revascularization methods in such patients. Methods: A total of 105 patients with type B aortic dissection treated by TEVAR combined with LSA revascularization in our hospital from March 2013 to March 2020 were statistically analyzed. According to the method of LSA revascularization, they were divided into four groups: HT group (41 cases), CG group (29 cases), SBSG group (21 cases), IVF group (14 cases). General information, perioperative, postoperative and follow-up data of the four groups of patients were collected, statistical methods were used to compare the above data between groups. Results: The success rate of the four groups of patients was 100%, there was statistical difference in the application rate of the four techniques in emergency surgery of type B AD (P<0.05). And the HT group had the highest rate of emergency surgery. Intraoperative blood loss, contrast agent usage, fluoroscopy time, operative time, total hospitalization cost, and incidence of LSA ischemia symptoms during follow-up in the four groups were significantly different (P<0.05). Pairwise comparison among groups showed that the intraoperative blood loss and operative time in HT group were highest (adjusted P<0.0083;P<0.05). According to the amount of intraoperative contrast medium and the duration of fluoroscopy, SBSG group>IVF group>CG group>HT group. The total hospitalization cost of SBSG group was significantly higher than that of the other three groups (P<0.05), the incidence of LSA ischemia symptoms was the highest in the IVF group during the follow-up period. The incidence of complications (except LSA ischemia symptoms) during the perioperative period and the follow-up period among the four groups were similar (P>0.05), the median follow-up time of HT group, CG group, SBSG group and IVF group was significantly different (P<0.05), and HT group had the longest follow-up time. Conclusion: All the four LSA revascularization techniques could effectively restore LSA perfusion, and all of them could expand the application range of TEVAR in Type B AD. The application of SBSG technique in emergency Type B AD surgery was poor, but the short-term prognosis of patients was good. The HT, CG and IVF technique was comparable. However, both the operative time and intraoperative blood loss of HT were longer than those of other luminal LSA revascularization techniques, and the postoperative LSA patency of patients with IVF technique was poor. Each of the four LSA revascularization techniques has its own advantages and disadvantages, and this study still needs to be further verified in large-sample, multi-center randomized controlled studies. Keywords: Type B aortic dissection, Endovascular repair, Left subclavian artery, Revascularization
Pages63
URL查看原文
Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/462837
Collection第二临床医学院
Affiliation
第二临床医学院
First Author AffilicationSecond Clinical School
Recommended Citation
GB/T 7714
张朋宾. 左锁骨下动脉4种重建技术在B型主动脉夹层腔内修复术中的应用对比研究[D]. 兰州. 兰州大学,2021.
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