两种开胸小切口在自膨式可吸收肺动脉支架行经导管置入术实验研究

Transcatheter self-expandable stent implantation in pulmonary artery with two approaches of small incision thoracotomy

目的比较经胸骨旁右第4肋间切口与左侧腋下切口在实验动物的肺下叶动脉的支架置入的应用价值。方法选择健康清洁级实验猪8只,并将其随机分为右室流出道路径组(A组)和肺动脉总干路径组(B组),每组各4只。A组开胸途径采用胸骨旁右第4肋间切口,B组行左侧腋下切口,两组均行自膨式可吸收支架的肺下叶动脉置入术。术后对两组实验猪的一般情况、肺下叶动脉血管直径变化情况、并发症等观察记录,并通过随访3个月后评估实验猪的支架置入情况。结果 B组手术时间明显短于A组,两组间比较,差异有统计学意义(P<0.05)。两组在透视时间、置入前后的血管直径方面比较,差异均无统计学意义(P>0.05)。术后选择性肺动脉造影显示,两组实验猪下叶动脉的置入前血管直径比较,差异无统计学意义(P>0.05)。置入后,两组血管直径均变大,两组间比较,B组改善程度显著高于A组(P<0.05)。两组术后均未出现心律失常、心包积液、心功能不全等并发症,且支架张开充分。术后3个月,将所有实验猪处死并解剖其心脏后发现,置入的支架位置准确,形态良好,支架表面部分内膜化,支架内未见明显血栓。结论经胸骨旁右第4肋间切口和左侧腋下切口在实验动物的下叶动脉的支架置入应用中,均显示了较好的临床安全性。而且,与胸骨旁右第4肋间切口比较,左侧腋下切口途径操作简单,创伤小,疗效满意。

Objective To investigate the value of the placement of stent in the inferior lobar pulmonary artery through ap- proaches of parasternal fight fourth intercostal incision and left subaxillary incision in the experimental animals. Methods Eight healthy and clean pigs were selected, and they were randomly divided into the right ventricular outflow tractpathway group（ Group A）and pulmonary trunk pathway group（ Group B） ,with 4 pigs in each group. In the fight ventrie- ular outflow tract, the thoracic approach was performed by parasternal right fourth intercostal incision, and the trunk of the pulmonary arterywas performed by left subaxillary incision. The pigs in both groups were treated with self expandable stents in the lower lobar pulmonaryartery. The general situation of the two groups of experimental pigs, the changes of the diameter of the pulmonary artery, and the complications were recorded. The stent implantation of the experimental pigs was evaluated after 3 months follow-up. Results The operation time in Group B was significantly shorter than that in Group A （ P 〈 0. 05 ）. The fluoroseoDv time. vascular diameter before and after the implantation had no statisticaflv significant difference（P 〉0. 05 ）. Postoperative pulmonary angiography showed that vascular diameters of lobar pulmonary artery of the two groups of pigs before implantation had no statistically significant difference（ P 〉 0. 05 ）. After implantation,the vessel diame- ters of two groups were all increased ,the improvement in Group B was significantly higher than that in Group A（ P 〈0. 05 ）. No arrhythmia,perieardial effusion and cardiac dysfunction were found alter operation, and the stents wez~ open enough. Three months after the operation,all the pigs were sacrificed and dissected,and the stents were found to be in correct posi- tion with good shape. The surface of stent was partially intimal and no obvious thrombus was found in the stent. Conclusion Both approaehesof parasternal rightfourth intercostal incision and left subaxillary incision have good clinical safety in the implantation of lower lobe pulmonary stent. Compared between these two approaches,the left subaxillary inci- sion approach has the advantages of simple operation ,small trauma, satisfactory curative effect.