分步定位释放技术在Stanford B型主动脉夹层开窗治疗中的应用效果

Application effect of step-by-step localization and release technique in fenestration treatment of stanford type B aortic dissection

目的探讨分步定位释放技术在缺乏近端锚定区的Stanford B型主动脉夹层开窗治疗中的疗效与安全性。方法收集2018年1月至2022年12月滨州医学院烟台附属医院收治的43例Stanford B型主动脉夹层患者的临床资料,所有患者的近心端第一破口累及左锁骨下动脉(LSA)或距离LSA小于15 mm。按照治疗方法的不同将Stanford B型主动脉夹层患者分为A组(n=18,采用传统定位方法重建弓上血运)和B组(n=25,采用分步定位释放技术重建弓上血运)。所有患者出院后随访3~12个月,比较两组患者围手术期和术后随访相关指标。结果所有患者均成功采用开窗技术处理主动脉弓部病变并保留弓上动脉。两组患者手术成功率均为100%,均未出现手术入路相关并发症。两组患者术前双侧肱动脉血压差比较,差异无统计学意义(P>0.05)。A组患者的手术时间短于B组患者,造影剂用量少于B组患者,差异均有统计学意义(P<0.05)。术后即刻造影显示,两组患者术后急性肾功能损伤、内漏的发生率比较,差异均无统计学意义(P>0.05)。A组患者术后双上肢肱动脉血压差明显大于B组患者,差异有统计学意义(P<0.01)。两组患者术后脊髓缺血、脑卒中、夹层复发、破溃死亡的发生率比较,差异均无统计学意义(P>0.05)。结论分步定位释放技术指导的开窗技术术后短期内患者脑卒中、脊髓缺血、复发、死亡的发生风险低。该术式对LSA的重建效果良好,术后双侧肱动脉血压差改善明显,现阶段值得在临床推广应用。

Objective To investigate the safety and efficacy of step-by-step localization and release technique in the treatment of Standford B aortic dissection without proximal anchorage zone.Method The clinical data of 43 Stanford type B aortic dissection patients admitted to Yantai Affiliated Hospital of Binzhou Medical University from January 2018 to December 2022 were collected.The first breach near the heart of all patients were adjacent to the left subclavian artery(LSA)or less than 15 mm away from the LSA.According to different treatment methods,the patients were divided into the group A(n=18,traditional screen mark positioning)and the group B group(n=25,step-by-step localization and release technique).All patients were followed up for 3-12 months after discharge,the perioperative and postoperative follow-up related indicators were compared between the two groups.Result All patients were successfully treated with fenestration technique for aortic arch lesions and preserve the superior arch artery.The success rate of operation in two groups were 100%,and there were no complications related to the surgical approach.There was no statistically significant difference in preoperative bilateral brachial artery blood pressure difference between the two groups before operation(P>0.05).The surgical time of group A patients was shorter than that of group B patients,and the dosage of contrast agent was less than that of group B patients,and the differences were statistically significant(P<0.05).The postoperative difference in bilateral brachial artery blood pressure in group A patients was significantly greater than that of group B patients,and the difference was statistically significant(P<0.01).There were no statistically significant differences in the incidence of postoperative spinal cord ischemia,stroke,dissection recurrence,and rupture death between the two groups of patients(P>0.05).Conclusion The fenestration guided by the step-by-step localization and release technique has a low risk of stroke,spinal cord ischemia,recurrence,and death in patients followed up in the short-term postoperative period.This technique is effective in the reconstruction of LSA,and the postoperative improvement of bilateral brachial artery blood pressure difference is obvious,and it is worth to be popularized and applied in the clinic at this stage.