外科理论与实践

外科理论与实践 ›› 2022, Vol. 27 ›› Issue (04): 318-323.doi: 10.16139/j.1007-9610.2022.04.009

• 论著 • 上一篇    下一篇

3D参数曲面平面拓扑导板在主动脉开窗/分支支架腔内修复技术中的临床应用

付东生1, 刘昭1(), 杨超2(), 李沁2, 陈阁政2, 孙莉莉1, 李文东1, 周敏捷3, 刘晨1, 乔彤1, 李毅清2, 李晓强1   

  1. 1.南京大学医学院附属鼓楼医院血管外科,江苏 南京 210008
    2.华中科技大学同济医学院附属协和医院血管外科,湖北 武汉 430022
    3.云智愈(南京)医疗科技有限公司,江苏 南京 211215
  • 收稿日期:2022-05-30 出版日期:2022-07-25 发布日期:2022-09-20
  • 通讯作者: 刘昭,杨超 E-mail:liuzhao83@gmail.com;ychao@hust.edu.cn
  • 基金资助:
    江苏省重点研发计划(社会发展)(BE2019604)

Clinical application of 3D parametric surface planar topological guide plate in fenestrated/branched endovascular aortic repair technique

FU Dongsheng1, LIU Zhao1(), YANG Chao2(), LI Qin2, CHEN Gezheng2, SUN Lili1, LI Wendong1, ZHOU Minjie3, LIU Chen1, QIAO Tong1, LI Yiqing2, LI Xiaoqiang1   

  1. 1. Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliate Hospital of Nanjing University Medical School, Jiangsu Nanjing 210008, China
    2. Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Wuhan 430022, China
    3. Cloud Cure Medical Technology Co.,Ltd., Jiangsu Nanjing 211215, China
  • Received:2022-05-30 Online:2022-07-25 Published:2022-09-20
  • Contact: LIU Zhao,YANG Chao E-mail:liuzhao83@gmail.com;ychao@hust.edu.cn

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摘要：

目的：应用3D参数曲面平面拓扑导板,采取预开窗和分支支架技术,总结完全血管腔内修复对累及主动脉重要分支弓部及胸腹主动脉病变的效果。方法：2020年8月至2022年4月,南京大学医学院附属鼓楼医院及华中科技大学同济医学院附属协和医院收治累及重要分支的复杂主动脉病变病人17例。男14例,女3例,平均年龄(61.06±11.23)(39~78)岁。病变为主动脉弓部动脉瘤4例,夹层4例;胸腹主动脉瘤5例,夹层4例。急诊手术6例,择期手术11例。术前根据主动脉CT血管造影制作3D参数曲面平面拓扑导板。术中在平面导板引导下,采用预开窗技术、内/外分支支架技术行完全腔内修复。共行开窗/分支支架50条。结果：所有手术均一期完成,无中转开放手术。平均手术时间(4.57±2.29)(1.50~10.67) h,无肾功能不全和截瘫,无分支动脉丢失。1例(5.88%)围术期死亡。随访发现内漏2例(11.76%),分别为Ⅰc和Ⅲc型内漏。结论：应用3D参数曲面平面拓扑导板治疗复杂主动脉累及分支的病变,完全微创。本技术较传统测量定位准确,较3D打印指导简洁迅速,2年内随访安全。

关键词: 3D参数曲面平面拓扑导板技术, 全腔内主动脉修复, 主动脉弓, 胸腹主动脉

Abstract:

Objective To summarize the experience and effect using 3D parametric surface planar topological guide plate technology in fenestrated/branched endovascular aortic repair (F/B EVAR) to repair aortic arch and thoracoabdominal aortic lesions involving important aortic branches. Methods From August 2020 through April 2022, 17 patients [14 males and 3 females, mean age of(61.06±11.23)(39-78) years] with complex aortic lesions involving important branches were treated in both Nanjing Drum Tower Hospital and Union Hospital. There were 8 cases with aortic arch aneurysms 4 cases and dissections 4 cases, respectively, and 9 cases with thoracoabdominal aortic aneurysms 5 cases and dissections 4 cases, respectively. Six cases were urgent operation and 11 cases were selective operation. Before operation, 3D parametric surface planar topological guide plate was made according to aortic computed tomography angiography. Under the guidance of planar guide plate, pre-fenestrated and external/internal branched and other endovascular aortic repair was performed. Totally, 50 fenestrated/branched stent grafts were planted. Results All operations were completed without conversion to open surgery. Average operative time was (4.57±2.29)(1.50-10.67) h. There was no renal insufficiency, paraplegia and loss of branch arteries. One patient (5.88%) died during perioperative period. Within the follow-up, there were 2 cases (11.76%) of endoleak type Ⅰc and type Ⅲc, respectively. Conclusions F/B EVAR under the guidance of 3D parametric surface planar topological guide plate is a minimally invasive treatment. The technology is more accurate than traditional measurement and positioning, faster than 3D printing guidance, and safe and reliable shown in the follow-up.

Key words: 3D parametric surface planar topological guide plate technology, Endovascular aortic repair, Aortic arch, Thoracoabdominal aorta

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