完全穿刺技术在主动脉支架植入术中的应用观察

Application of complete puncture procedure in aortic stejnt implantation

目的探讨应用Perclose Proglide缝合器完全穿刺技术在主动脉支架植入术中的安全性和有效性方法预置缝合器技术(Preclosing技术)是指在放置直径达到20-25F的鞘管前,将两个或多个6FPerclose Proglide装置预置于股动脉内。手术完成后用缝合线缝合动脉破口。在2009年8月至2011年11月对行胸主动脉腔内修复的患者(A组)使用Preclosing技术,将其资料与2007年1月至2009年9月使用主动脉夹层患者(B组)比较。衡量标准包括技术成功率、早期并发症、麻醉方法、手术时间、心脏病监护病房(CCU)停留时间、从手术到出院时间、是否需住院、手术费用以及医疗费用。结果两组基本特征、主动脉瘤内套膜支架模型或剖面图无明显差异。A组技术成功率为100%(32/32),B组为97.4%(64/66)(P<0.05)。两组中都无穿刺点相关死亡。B组早期并发症的发生率比A组低(9.4%vs22.5%,P<0.01)。A组中较多地使用清醒镇静局部麻醉(68.2%),B组为51.7%(P<0.01)。A组手术时间较短,(96±33)分钟,而B组为(127±41)分钟(P<0.01)。A组中,心脏病监护病房停留时间、从手术到出院时间以及住院时间都减少了,分别为(117.3±88.3)小时,(7.5±5.3)天和(15.3±6.8)天,而B组分别为(132.7±115.5)小时,(10.5±5.0)天和(19.5±7.8)天,(P<0.01)。结论用Preclosing技术的完全穿刺技术在腹主动脉瘤腔内修复术中的应用是安全和有效的,其技术精湛,可供患者选择。

Objective To investigate the safety and effectiveness of complete puncture procedure using Perclose ProGlide vascular closure device in aortic stent implantation. Methods The Preclosing technique involved two or more 6 F Perclose ProGlide devices deployed in the femoral artery before placement of a 20-25 F sheath. Sutures were used to close the artery at the end of the procedure. The clinical data of the patients who underwent thoracic endovascular aortic repair （TEVAR） using Preclosing technique from August 2009 to November 2011 （group A） were compared with those of the patients with aortic dissection who received operation from January 2007 to September 2009 （group B）. Outcome measures included technical success rate, early complications, anesthesia method, procedure duration, length of cardiac care unit （CCU） stay, time from procedure to discharge, whether to need hospital stay, procedure expense, and hospitalization cost. Results There were no significant differences in baseline characteristics, endograft model, or profiles between the two groups. The technical success rate was 100.0% （32/32） in group A vs. 97.4% （64/66） in group B （P〈0.05）. There was no access-related mortality in both groups. Group B had lower incidence of early complications than group A （9.4% vs 22.5%, P〈0.01 ）. Local anesthesia with conscious sedation was used more often in group A than in group B （68.2% vs 51.7%, P〈0.01 ）. The procedure duration was shorter in group A than in group B （96±33 min vs 127±41 min, P〈0.01 ）. Compared with those in group B, the length of CCU stay, time from procedure to discharge, and hospital stay in group A were shortened （117.3±88.3 hrs vs 132.7±115.5 hrs, P〈O.O1; 7.5±5.3 d vs 10.5±5.0 d, P〈0.01; 15.3±6.8 d vs 19.5± 7.8 d, P〈0.01 ）. Conclusion Complete puncture procedure using Preclosing technique is safe and effective in TEVAR for treating aortic aneurysm.