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ENGLISH ABSTRACT
3D打印指导下开窗/分支支架治疗胸腹主动脉病变：全国多中心回顾性研究
韩月雪
金怡
付东生
胡健航
段剑锋
孙莉莉
王冕
于浩
苏奕明
华正东
陈志丹
郭世奎
化召辉
李晓强
刘昭
作者及单位信息
·
DOI： 10.3760/cma.j.cn113855-20230818-00067
3D print-guided fenestration/branch stent treatment of abdominal aortic disease: a national multicenter retrospective study
Han Yuexue
Jin Yi
Fu Dongsheng
Hu Jianhang
Duan Jianfeng
Sun Lili
Wang Mian
Yu Hao
Su Yiming
Hua Zhengdong
Chen Zhidan
Guo Shikui
Hua Zhaohui
Li Xiaoqiang
Liu Zhao
Authors Info & Affiliations
Han Yuexue
Department of Vascular Surgery, Drum Tower Hospital, Nanjing University School of Medicine, Nanjing 210008, China
Jin Yi
Department of Vascular Surgery, Drum Tower Hospital, Nanjing University School of Medicine, Nanjing 210008, China
Fu Dongsheng
Department of Vascular Surgery, Drum Tower Hospital, Nanjing University School of Medicine, Nanjing 210008, China
Hu Jianhang
Department of Vascular Surgery, Drum Tower Hospital, Nanjing University School of Medicine, Nanjing 210008, China
Duan Jianfeng
Department of Vascular Surgery, Drum Tower Hospital, Nanjing University School of Medicine, Nanjing 210008, China
Sun Lili
Department of Vascular Surgery, Drum Tower Hospital, Nanjing University School of Medicine, Nanjing 210008, China
Wang Mian
Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510062, China
Yu Hao
Department of Cardiovascular Surgery, Southern Theater General Hospital, Guangzhou 510010, China
Su Yiming
Department of Vascular Surgery, Liuzhou Workers' Hospital, Liuzhou 545005, China
Hua Zhengdong
Heart Center, Wuhan Asian Heart Hospital, Wuhan 430056, China
Chen Zhidan
Department of Vascular Surgery, Xiangyang City Center Hospital, Xiangyang 441021, China
Guo Shikui
Department of Vascular Surgery, Yunnan First People's Hospital, Kunming 650032, China
Hua Zhaohui
Department of Endoluminal Vascular Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
Li Xiaoqiang
Department of Vascular Surgery, Drum Tower Hospital, Nanjing University School of Medicine, Nanjing 210008, China
Liu Zhao
Department of Vascular Surgery, Drum Tower Hospital, Nanjing University School of Medicine, Nanjing 210008, China
·
DOI： 10.3760/cma.j.cn113855-20230818-00067
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摘要

目的探讨应用3D打印技术指导开窗/分支支架技术（fenestrated /branched endovascular repair，F/B-EVAR）血管腔内修复胸腹主动脉疾病的经验。

方法回顾性分析2018年2月至2023年3月全国范围内69家医疗中心采用3D打印技术指导医师自制支架行F/B-EVAR修复胸腹主动脉病变共316例患者的临床及随访资料。

结果本组中位随访时间23个月（2~60个月），随访丢失24例，随访率92.4%（292/316），平均术后住院时间（8.2±4.9）d，共重建胸腹主段分支动脉944条。术中11条分支动脉重建失败，成功率98.8%（933/944）。术后30 d内，死亡8例，死亡率2.5%，随访中死亡6例，共死亡14例，死亡率4.4%（14/316）。脊髓缺血11例（3.5%），无永久性截瘫。术后肾功能损伤19例（6.0%）。术后26例患者检查中发现内漏，内漏率8.2%。

结论3D打印技术可对分支动脉位置个体化精准定位，同时简化手术流程，缩短学习曲线且临床疗效较佳。

主动脉瘤，腹;主动脉瘤，胸;3D打印;开窗分支支架技术
ABSTRACT

ObjectiveTo study the application of 3D printing technology in multi-center fenestrated/branched endovascular repair (F/B-EVAR) for endovascular repair of abdominal aortic diseases.

MethodsFrom Feb 2018 to Mar 2023, The clinical and followup data of 316 cases of abdominal aortic lesions undergoing repair with F/B-EVAR at 69 medical centers nationwide using 3D printing technology to guide physician-modified stent graft were retrospectively analyzed.

ResultsThe mean follow-up time of the patients was 23 months (2-60 months), and 24 cases were lost to follow up, the follow-up rate was 92.4% (292/316), the mean postoperative hospitalization time was (8.2±4.9) days. A total of 944 main abdominal branch arteries were reconstructed. Intraoperative reconstruction of 11 branches failed, with a success rate of 98.8% (933/944). Within 30 days after surgery, 8 patients died (2.5%), and 6 patients died during follow-up, a total of 14 patients died (4.4%). There were 11 cases (3.5%) of spinal cord ischemia and no patient suffered from permanent paraplegia. There were 19 patients (6.0%) with postoperative renal function injury. Internal leakage was found in 26 patients, and the rate of internal leakage was 8.2%.

Conclusion3D printing technology can accurately locate the location of branch arteries, simplifing the surgical process, shortening the learning curve , and improving clinical efficacy.

Aortic aneurysms,abdominal;Aortic aneurysms,thoracic;3D printing;Fenestrated and branched endovascular aortic repair
Liu Zhao, Email: mocdef.labiamg38oahzuiL
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引用本文

韩月雪,金怡,付东生,等. 3D打印指导下开窗/分支支架治疗胸腹主动脉病变：全国多中心回顾性研究[J]. 中华普通外科杂志,2024,39(07)：527-533.

DOI:10.3760/cma.j.cn113855-20230818-00067

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近年来，随着血管外科手术技术和新型血管介入材料的发展，微创血管腔内治疗技术（endovascular aortic repair，EVAR）已成为主动脉疾病治疗的发展方向。而对于累及重要内脏动脉分支的胸腹主动脉病变，因其特殊的解剖结构、复杂的血流动力学环境及分支重建难度大等不利因素，腔内介入易造成内漏、截瘫等严重术后并发症。开窗分支支架技术（fenestrated and branched endovascular aortic repair，F/B-EVAR）具有手术创伤小、并发症少、内漏率低、分支支架闭塞率低等优势 ［ 1 , 2 ］ ，但目前商品化的和医师自制的开窗支架或分支支架，大多是根据影像学检查，通过测量方法设计手术方案，选择开窗位置，在复杂解剖的病变中传统方法难以精确定位，存在局限。随着3D打印技术的发展，术中3D打印模型辅助成为一种个体化的精准定位方法 ［ 3 , 4 ］ 。本研究收集国内69家中心（19个省市自治区）2018年2月至2023年3月间采用3D打印引导F/B-EVAR治疗胸腹主动脉病变316例患者的临床随访资料，总结报道如下。
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备注信息
A
刘昭，Email： mocdef.labiamg38oahzuiL
B

韩月雪：起草文章，酝酿和设计实验，统计并分析数据；金怡、付东生、胡健航，：采集数据、分析/结解释数据；段剑锋、孙莉莉：获取研究经费；王冕、于浩、苏奕明、华正东、陈志丹、郭世奎、化召辉：实施研究，支持性贡献；李晓强、刘昭：实施研究，对文章的知识性内容作批阅性审阅，获取研究经费，行政、技术或材料支持

C
韩月雪, 金怡, 付东生, 等. 3D打印指导下开窗/分支支架治疗胸腹主动脉病变：全国多中心回顾性研究[J]. 中华普通外科杂志, 2024, 39(7): 527-533. DOI: 10.3760/cma.j.cn 113855-20230818-00067.
D
所有作者均声明不存在利益冲突
E
国家自然科学基金 (82370520)
江苏省卓博计划 (2022ZB689)
南京鼓楼医院临床研究专项资金 (2023-LCYJ-PY-23)
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