不同类型“烟囱”支架介入的主动脉腔内修复术在主动脉弓病变中的近中期疗效

Short-and mid-term efficacy of endovascular repair of aortic arch lesions with different types of chimney stents

目的分析在主动脉弓病变治疗中,采用不同类型"烟囱"支架介入的主动脉腔内修复术的近中期疗效。方法选取2015年1月至2016年12月收治的40例主动脉弓病变患者为研究对象,根据入院时间不同被随机分为A组和B组,每组20例。所有患者均给予"烟囱"支架介入的主动脉腔内修复术,但支架类型不同,A组给予自膨式裸"烟囱"支架,B组给予覆膜"烟囱"支架。记录并比较两组患者手术情况(支架位置、动脉顺畅情况、脑缺血及上肢缺血等)、住院情况(手术时间、住院时间和住院费用)及近中期并发症(内漏、血栓形成、肾功能异常、支架移位及腰背部疼痛)等。结果所有患者均顺利完成手术,术后主动脉CT造影显示,各"烟囱"支架位置良好,各动脉供血基本通畅,术中均无出血、脑梗死及心肾衰竭等严重疾病出现。两组患者在手术时间、住院时间及住院费用上差异均无统计学意义(P均>0.05)。B组血栓形成发生率高于A组(P<0.05),但在内漏、肾功能异常、支架移位和腰背部疼痛发生率上两组差异无统计学意义(P均>0.05)。结论两种类型"烟囱"支架介入的主动脉腔内修复术治疗主动脉弓病变各有优劣,但自膨式裸"烟囱"支架在减少血栓形成上优于覆膜"烟囱"支架。

Objective To explore the short- and mid- term efficacy of endovascular repair of aortic arch lesions with different types of chimney stent. Methods Forty patients with aortic arch disease treated from January 2015 to December 2016 were selected as research objects and were randomly divided into group A and group B（ n = 20 ,each） according to the time of admission. Endovascular repair with self expandable naked chimney stent was given in group A, and endovascular repair with film-covered chimney stent was given in group B. The surgical condition （ stent position, artery smooth, cerebral ischemia and upper limb ischemia） , the hospitalization status （operation time, hospitalization time and costs） and the short- and mid-term complications （leakage,thrombosis ,renal dysfunction, stent displacement and back pain） were recorded and compared between two groups. Results The operations were performed successfully in all patients. The postoperative CT angiography showed that all the chimney stents were in good position and the blood supply of each artery was unobstructed. There were no serious diseases such as hemorrhage, cerebral infarction, heart and kidney failure occurring during the operation. There were no significant differences in operation time, hospital stay and hospitalization expenses between two groups （ all P 〉 0. 05 ）. The incidence of thrombosis in group B was statistically higher than that in group A （ P 〈 0. 05 ） , but there were no significant differences in the incidences of internal leakage, renal dysfunction, stent displacement and back pain between two groups （ all P 〉 0.05 ）. Conclusion There are respective advantages and disadvantages in two types of ＂chimney＂ stent for endovascular repair of aortic arch lesions, however, the self expandable naked chimney stent is superior to the film-covered chimney bracket in reducing thrombosis.