主动脉夹层腔内隔绝术后Perclose ProGlide血管缝合器的临床应用

Clinical application of Perclose ProGlide suture homeostasis device after endovascular graft exclusion for aortic dissection

目的:评价经皮股动脉穿刺完成主动脉夹层(aortic dissection,AD)腔内隔绝术(endovascular graft exclusion,EVGE)后应用Perclose ProGlide(Abbott,USA)血管缝合器止血的安全性和可靠性。方法:2004-2012年我院收治的200例Stanford B型AD患者,根据在局麻或者全麻下完成主动脉EVGE随机分组。100例为对照组,经外科纵行切开腹股沟区皮肤4.0～6.0 cm,暴露股动脉2.0～3.0 cm后穿刺建立股动脉建立入路完成手术。100例为观察组,经皮股动脉穿刺建立股动脉入路完成手术,术后常规使用2套装置缝合血管。结果:观察组使用两套缝合装置成功率95.0%(95/100)。对照组和观察组手术时间分别为(113.0±16.0)min和(90.0±12.1)min,差异具有统计学意义(P<0.01)。其中建立股动脉入路的时间分别为(14.0±1.3)min和(4.3±0.8)min,差异具有统计学意义(P<0.01),退鞘后股动脉处理时间分别为(8.9±1.3)min和(3.0±0.7)min,差异具有统计学意义(P<0.01),术后制动时间分别为(18.5±1.9)h和(7.7±2.3)h,差异具有统计学意义(P<0.01),术后平均住院时间分别为(5.2±1.0)d和(3.3±0.8)d,差异有具有统计学意义(P<0.01)。并发症发生率分别为5.0%和4.0%,差异无统计学意义(P>0.05),伤口不适感分别为36例(36.0%)和17例(17.0%),差别有统计学意义(P<0.01)。结论:AD EVGE后应用Perclose ProGlide血管缝合器止血是一种安全、可靠的止血方法,可以缩短手术时间、建立股动脉入路的时间、术毕股动脉处理时间、术后制动时间、术后平均住院时间且并发症少,值得进一步推广。

Objective：To evaluate the safety and reliability of applying Perclose ProGlide suture homeostasis device（Abbott,USA）after percutaneous femoral artery puncture and endovascular graft exclusion（EVGE）for aortic dissection.Methods：Totally 200 patients with Stanford type B aortic dissection from 2004 to 2012 in our hospital were enrolled and were randomized into control group（n=100） and observation group（n=100） according to EVGE for aortic dissection under local anesthesia or general anesthesia.Skin in inguinal region of patients in control group was longitudinally incised 4.0-6.0 cm and was exposed 2.0-3.0 cm;femoral artery puncture was performed soon to establish femoral artery path.Patients in observation group underwent femoral artery puncture to establish femoral artery path and two sets of Perclose ProGlide devices were conventionally used after the operation.Results：Success rate of two sets of Perclose ProGlide suture devices in observation group was 95.0%（95/100）.Operation time in control group and observation group was（113.0±16.0） min and（90.0±12.1） min respectively,with significant statistical differences（P〈0.01）.Femoral artery path establishment time was（14.0±1.3）min and（4.3±0.8）min respectively,with significant statistical differences（P0.01）.Vascular processing time after exiting the sheath was（8.9±1.3）min and（3.0±0.7）min respectively,with significant statistical differences（P0.01）.Postoperative braking time was（18.5±1.9）h and（7.7±2.3）h respectively,with significant statistical differences （P0.01）.Postoperative average hospitalization time was（5.2± 1.0）d and（3.3 ± 0.8）d respectively,with significant statistical differences（P0.01）.Complications incidences were 5% and 4% respectively,without statistically differences（P〈0.05）.Wound discomfort was respectively observed in 36 cases（36.0%） and 17 cases（17.0%）,with significant statistically differences（P〈0.01）.Conclusions：Clinical application of the Perclose ProGlide suture hemostasis device after EVGE for aortic dissection is a safe and reliable method,which can reduce operation time,femoral artery path establishment time,vascular processing time after exiting the sheath,brake time,postoperative hospitalization time with low complication incidences.