激光原位开窗重建锁骨下动脉中期疗效与手术技巧分析

Surgical technique and mid-term evaluation of subclavian arterial reconstruction by in-situ laser fenestration

目的探讨激光原位开窗在主动脉疾病腔内治疗重建锁骨下动脉血流的手术技巧与中期疗效。方法回顾性分析郑州大学第一附属医院2017年3月至2018年3月收治的34例胸主动脉腔内修复术(TEVAR)并激光原位开窗重建锁骨下动脉患者,随访12个月,统计支架通畅率并总结手术技巧。结果激光原位开窗成功32例,手术成功率94.1%。术后截瘫1例,积极治疗后恢复,围术期并发症发生率2.94%;术后死亡1例,死亡率2.94%。术后12个月复查证实分支动脉支架通畅率100%,未见内漏、新发破口或夹层逆撕形成。结论激光原位开窗重建锁骨下动脉作为一项微创实用的技术,成功率高,围术期并发症少,中期疗效良好。

Objective To investigate the surgical technique and mid-term effect of subclavian arterial reconstruction by in situ laser fenestration in aortic disease. Methods Clinical data of 34 patients with in situ laser fenestration during thoracic aortic repair (TEVAR) in the First Affiliated Hospital of Zhengzhou University from March 2017 to March 2018 was analysis retrospectively. All patients were followed up for 1 year and the patency rate of stent was calculated, and the operative skills were summarized. Results 32 cases were successful;the success rate was 94.1%. There is one case paralyzed was recovered after therapy;the incidence of perioperative complications was 2.94%. 1 case died after the surgery;the mortality rate was 2.94%. The computed tomography angiography at 12 months after the operation confirmed that the patency rate of the branch artery stent was 100%. There was no internal leakage, new tear or reverse tear of the dissection was found. Conclusion As a minimally invasive and practical technique, in situ laser fenestration for subclavian arterial reconstruction owns a high success rate, less perioperative complications and good mid-term effect.