3D打印辅助复杂胸主动脉血管病变分支支架腔内修复手术治疗的临床分析_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

李晓莉 ¹ , 何平 ² , 张大勇 ³ , 王汉 ¹ ,  张本贵 ³

1. ;
2. ;
3. ;

Corresponding author：

张本贵, Email: 190113996@qq.com

Keywords：

3D打印; 复杂胸主动脉血管病变; 分支支架

DOI：

10.7507/1007-4848.201907017

Video：

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目的探讨 3D 打印辅助复杂胸主动脉血管病变 Castor 分支支架腔内修复手术治疗的可行性。方法纳入 2018 年 9～12 月急性 Stanford B 型主动脉夹层或主动脉弓部血管病变拟行腔内介入支架手术的 4 例患者，年龄分别为 65、55、45、39 岁。患者均缺乏足够的左锁骨下近端锚定区，或病变累及弓部血管无法采用常规单纯支架置入术。手术均采用 Castor 分支支架，术前采用三维 CT 血管造影（3D-CTA）及 3D 打印技术对主动脉弓部血管解剖进行精确刻画，并辅助手术策略制定及进行器械模拟植入。结果 3 例为累及左锁骨下动脉的 Stanford B 型夹层（1 例合并升主动脉瘤），1 例为主动脉弓部穿通性溃疡。4 例患者手术顺利，1 例患者同期行体外循环升主动脉置换。患者术后 CTA 提示效果满意，无内漏、支架移位及卒中等严重并发症出现，30 d 随访患者状态良好，无不良严重并发症出现。结论 3D 打印辅助复杂胸主动脉血管病变分支支架腔内修复手术具有很好的可行性及诸多潜在优势。

Citation： 李晓莉, 何平, 张大勇, 王汉, 张本贵. 3D打印辅助复杂胸主动脉血管病变分支支架腔内修复手术治疗的临床分析. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(2): 223-227. doi: 10.7507/1007-4848.201907017 Copy

1.	Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med, 1999, 340(20): 1546-1552.
2.	Xiong J, Jiang B, Guo W, et al. Endovascular stent graft placement in patients with type B aortic dissection: a meta-analysis in China. J Thorac Cardiovasc Surg, 2009, 138(4): 865-872.
3.	董智慧, 符伟国, 王玉琦, 等. 胸主动脉腔内修复扩展近端锚定区的探讨. 中华外科杂志, 2005, 43(13): 857-860.
4.	皮勇, 邢昕, 桂文芳, 等. 人工开窗型覆膜支架治疗复杂腹主动脉瘤的临床研究. 临床外科杂志, 2013, 21(5): 397-398.
5.	姜维良. 国产castor 主动脉弓分支支架临床应用初期经验. 中国医师杂志, 2014, 16(3): 323-325.
6.	马军, 孙占峰, 张英男, 等. 一体式分支支架治疗主动脉弓部疾病临床单中心初期结果. 中国血管外科杂志(电子版), 2014, 6(4): 208-211.
7.	Saito N, Kimura T, Odashiro K, et al. Feasibility of the Inoue single-branched stent-graft implantation for thoracic aortic aneurysm or dissection involving the left subclavian artery: short- to medium-term results in 17 patients. J Vasc Surg, 2005, 41(2): 206-212.
8.	Roselli EE, Arko FR 3rd, Thompson MM, et al. Results of the valiant mona LSA early feasibility study for descending thoracic aneurysms. J Vasc Surg, 2015, 62(6): 1465-1471.
9.	Finotello A, Marconi S, Pane B, et al. Twelve-year follow-up post-thoracic endovascular repair in type b aortic dissection shown by three-dimensional printing. Ann Vasc Surg, 2019, 55: 309.e13-309.e19.
10.	Kim WK, Kim T, Lee S, et al. 3d-printing-based open repair of extensive thoracoabdominal aorta in severe scoliosis. Semin Thorac Cardiovasc Surg, 2019, 31(1): 61-63.
11.	Yuan D, Luo H, Yang H, et al. Precise treatment of aortic aneurysm by three-dimensional printing and simulation before endovascular intervention. Sci Rep, 2017, 7(1): 795.

1. Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med, 1999, 340(20): 1546-1552.
2. Xiong J, Jiang B, Guo W, et al. Endovascular stent graft placement in patients with type B aortic dissection: a meta-analysis in China. J Thorac Cardiovasc Surg, 2009, 138(4): 865-872.
3. 董智慧, 符伟国, 王玉琦, 等. 胸主动脉腔内修复扩展近端锚定区的探讨. 中华外科杂志, 2005, 43(13): 857-860.
4. 皮勇, 邢昕, 桂文芳, 等. 人工开窗型覆膜支架治疗复杂腹主动脉瘤的临床研究. 临床外科杂志, 2013, 21(5): 397-398.
5. 姜维良. 国产castor 主动脉弓分支支架临床应用初期经验. 中国医师杂志, 2014, 16(3): 323-325.
6. 马军, 孙占峰, 张英男, 等. 一体式分支支架治疗主动脉弓部疾病临床单中心初期结果. 中国血管外科杂志(电子版), 2014, 6(4): 208-211.
7. Saito N, Kimura T, Odashiro K, et al. Feasibility of the Inoue single-branched stent-graft implantation for thoracic aortic aneurysm or dissection involving the left subclavian artery: short- to medium-term results in 17 patients. J Vasc Surg, 2005, 41(2): 206-212.
8. Roselli EE, Arko FR 3rd, Thompson MM, et al. Results of the valiant mona LSA early feasibility study for descending thoracic aneurysms. J Vasc Surg, 2015, 62(6): 1465-1471.
9. Finotello A, Marconi S, Pane B, et al. Twelve-year follow-up post-thoracic endovascular repair in type b aortic dissection shown by three-dimensional printing. Ann Vasc Surg, 2019, 55: 309.e13-309.e19.
10. Kim WK, Kim T, Lee S, et al. 3d-printing-based open repair of extensive thoracoabdominal aorta in severe scoliosis. Semin Thorac Cardiovasc Surg, 2019, 31(1): 61-63.
11. Yuan D, Luo H, Yang H, et al. Precise treatment of aortic aneurysm by three-dimensional printing and simulation before endovascular intervention. Sci Rep, 2017, 7(1): 795.

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3D打印辅助复杂胸主动脉血管病变分支支架腔内修复手术治疗的临床分析

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