借助3D打印技术重建模型选择覆膜支架治疗Stanford A型主动脉弓部夹层(附15例报告)

3D printing technique for choosing the covered stent in treatment of Stanford A type aortic dissection

目的观察借助3D打印技术重建模型选择覆膜支架治疗Stanford A型主动脉弓部夹层的效果。方法将40例Stanford A型主动脉弓部夹层患者分为观察组(15例)和对照组(25例),观察组借助3D打印技术重建模型选择覆膜支架治疗,对照组采用主动脉全弓置换加"象鼻子"支架手术。比较两组围术期情况及术后随访结果。结果两组患者均顺利完成手术,无死亡病例。观察组心肺转流时间、心肌阻断时间、停循环或选择性脑灌时间、术后引流量、输血量分别为145.0 min、(79.0±5.2)min、(17.3±2.8)min、(1 097.9±162.6)m L、(2 070.0±383.5)m L,对照组分别为292.0 min、(121.3±6.6)min、(57.7±3.2)min、(1 566.2±254.0)m L、(3640±565.3)m L,两组比较,P均<0.05。观察组全部一次关胸,术后无脑部并发症出现,且无声音嘶哑者;对照组术后出现短暂、轻度精神症状2例,苏醒延迟1例,延迟关胸4例,声音嘶哑1例。观察组术后1个月检查显示主动脉弓部及头臂动脉内支架扩张贴壁满意,未发生内瘘及支架内血流流速变异,分支血管内支架血流通畅率100%,相应部位的假腔消失或被血栓填充,无与覆膜支架相关的并发症;对照组术后1个月检查显示无夹层复发,无与人工血管相关的术后并发症,1例患者术后声音嘶哑未能恢复,降主动脉内支架扩张满意。结论借助3D打印技术重建模型选择覆膜支架治疗Stanford A型主动脉弓部夹层效果较好,且心肺转流时间、心肌阻断时间、停循环或选择性脑灌时间明显缩短,术后引流量和输血量明显减少。

Objective To observe the effects of using 3D printing technology in choosing a covered stent in treatment of Stanford type A aortic arch dissection.Methods Forty patients with Stanford A type AD were divided into the observation group(15 cases)and control group(25 cases).The patients in the observation group chose the stent graft treatment by using the 3D printing technology to reconstruct the model,while in the control group,total aortic arch replacement and elephant trunk implantation were performed.The perioperative and postoperative follow-up results were compared between the two groups.Results All the patients in the two groups completed the operation without death.The time of cardiopulmonary bypass,myocardial blockade,stop circulation or selective cerebral reperfusion,and postoperative drainage and blood transfusion in the observation group were 145.0 min,(79.0±5.2)min,(17.3±2.8)min,(1 097.9±162.6)mL,and(2 070.0±383.5)mL,respectively,and they were 292.0 min,(121.3±6.6)min,(57.7±3.2)min,(1 566.2±254.0)mL,and(3640±565.3)mL,respectively,in the control group;significant differences were found between these two groups(all P<0.05).All patients in the observation group had their chests closed,no brain complications occurred after the operation,and there were no hoarseness in the patients.In the control group,there were 2 cases of patients with short-term and mild psychiatric symptoms,1 case of delayed resuscitation,4 cases of delayed chest closures,and 1 case of hoarseness.In the observation group,the postoperative one-month examination showed satisfactory expansion of stents in the aortic arch and brachiocephalic arteries,there was no variability in blood flow within the internal hemorrhoids and stents,the blood flow rate of the stents in the branch vessels was 100%,with disappeared pseudocoele or filled with thrombus,and no complications associated with stent grafts were found.In the control group,the postoperative one-month examination showed no recurrence of the dissection and no postoperative complications associated with prosthetic vessels,1 patient failed to recover after hoarseness with satisfactory stent expansion within the descending aorta.Conclusion The effects of using 3D printing technology to reconstruct the model in choosing a covered stent in treatment of Stanford type A aortic arch dissection is good,and we shorten the time of cardiopulmonary bypass,myocardial block time,circulation stop or selective cerebral irrigation time significantly,and decrease the postoperative drainage and blood transfusion obviously.