临床外科杂志 ›› 2018, Vol. 26 ›› Issue (11): 818-821.doi: 10.3969/j.issn.10056483.2018.11.006

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导丝抓捕器在Stanford B型主动脉夹层的应用分析

  

  1. 410007    长沙,湖南中医药大学第一附属医院血管外科
  • 收稿日期:2018-06-16 出版日期:2018-11-20 发布日期:2018-12-03
  • 通讯作者: 尹晓清,Email:xiaoqingyin62@163.com

Application analysis of guide wirecapture technique in the endovascular stent repair for Stanford B aortic dissection

  1. Department of Cardiothoracic surgery,the First hospital of Hunan University of Chinese Medicine,Changsha 410007,China
  • Received:2018-06-16 Online:2018-11-20 Published:2018-12-03

摘要: 目的  研究导丝抓捕器系统在Stanford B型主动脉夹层手术中的应用。方法  Stanford B型主动脉病人67例,将其分为两组,A组57例,采用逆向导丝引导行主动脉覆膜支架置入手术;B组10例,为逆向导丝引导技术失败后立即改为右侧桡动脉穿刺置入导丝抓捕系统,采用正、逆向结合行主动脉覆膜支架置入术。结果  A组手术成功率为85.1%,B组成功率为100.0%,两组成功率比较差异无统计学意义(P>0.05);A组主动脉夹层破口数为1.9±0.8,B组为3.4±0.8,两组比较差异有统计学意义(P<0.05);A组组织、器官灌注不良率少于B组(15.8%比60.0%,P<0.05);A组假腔为(21.7±7.4)mm,小于B组的(29.6±9.1)mm,两组比较差异有统计学意义(P<0.05);A组有3例术后并发左上肢灌注不良综合征,立即予以行左右腋动脉转流术,B组出现1例术后逆向撕裂进展为A型主动脉夹层,予行孙氏手术后,病人成功恢复痊愈出院。A组手术时间及射线曝光时间分别为(147.8±22.6)分钟和(267.1±29.1)秒,均短于B组的(174.2±26.2)分钟和(522.9±67.4)秒(P<0.05)。夹层破口越多,在一定程度上明显延长射线曝光时间(R2=0.47,95%CI:0.1051~0.9197,P<0.05),多数病例术后保持随访,均无明显内漏出现。结论  主动脉夹层破口较多增加手术难度,增加术中X线曝光时间。在复杂、多破口的Stanford B型主动脉夹层中使用导丝抓捕系统安全可靠,可获得较高的手术成功率。

关键词: 主动脉夹层, 导丝抓捕器, 血管内膜破口, X线曝光时间

Abstract: Objective    To investigate and analysis the treatment of Guide wirecapture technique in the endovascular stent repair for Stanford B aortic dissection.Method  67 consecutive patients with complex Stanford B aortic dissection.Our patients cohort were divided into those applied with retrograde technique endovascular stent repair(group A,n=57) and anterograde Guide wirecapture technique(group B,n=10).Compared the general characteristics,true and false lumen diameter,Xray exposure time,total surgical time and analysis the correlation between intimal rupture number and Xray exposure time.Result  There was no significant difference in success rate between group A and B(85.1% vs 100.0%,P>0.05).The intimal rupture number(Group A:1.9±0.8,Group B:3.4±0.8,P<0.05),tissue or organ poor perfusion case of group B(60.0%) was higher than that of group A(15.8%,P<0.05).The false lumen diameter of group B[(29.6±9.1)mm] was wider than that of group A[(21.7±7.4)mm,P<0.05)].3 patients of group A suffer from the left upper limb poor perfusion syndrome and conducted with rightleft axillary artery bypass.1 patient of group B suffered reversely tore after operation and progressed to A type aortic dissection,then conducted with Sun’ surgery and been completely reversed.The operation time and Xray exposure time of group B[(174.2±26.2)min and(522.9±67.4)s] was longer than that of groupA[(147.8±22.6)min and(267.1±29.1)s,P<0.05)].We conclude that the Xray exposure time may positively correlated with the intimal rupture number(R2=0.47,95%CI: 0.1051~0.9197,P<0.05).In most cases,followup was maintained and no obvious leakage occurred. Conclusion  We concluded that the increased intimal rupture number may increase the degree of surgical difficulty and the Xray exposure time.Guide wirecapture technique in the endovascular stent repair for complicated Stanford B aortic dissection  may be a safe  and reliable manner.

Key words: aortic dissection, guide wirecapture technique, intimal rupture, 〓ray exposure time

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