3D导航技术在主动脉腔内修复术中的应用

doi:10.3969/j.issn.1005-6483.2019.11.005

摘要/Abstract

摘要： 目的:评价3D导航及术中平板CT在主动脉腔内修复术中应用的可行性及技术优势。方法:本研究为回顾性单中心研究。2016年11月～2018年12月，38例主动脉疾病病人在3D导航技术及术中平板CT辅助下完成胸主动脉腔内修复术（TEVAR）及腹主动脉腔内修复术（EVAR），16例病人因近端锚定区不足行分支血管重建。同期收治40例病人完成常规主动脉腔内修复术，记录术中及术后随访情况，进行对比分析。结果:在主动脉腔内修复手术中，与常规DSA二维图像参考比较，术中应用3D导航和术中CT在减少造影剂量（TEVAR 60.31ml vs 73.34ml，P=0.032；EVAR 83.43ml vs 94.83ml，P=0.013），术中放射剂量（TEVAR 293.04mGy vs 385.71mGy，P=0.002；EVAR 431.84mGy vs 584.51mGy，P=0.043），造影次数（TEVAR 2.36 vs 3.56 P=0.016；EVAR 3.43 vs 4.01，P=0.029），手术时长（TEVAR 64.09min vs 71.42min P=0.001；EVAR 142.14min vs 153.39min P=0.057）的同时，降低了术后主动脉相关再干预风险（2.63% vs 10% P=0.042），满足了临床介入诊疗过程中对解剖位置的精确要求及术中治疗效果的即时评估。结论:3D导航技术及术中平板CT在复杂主动脉腔内治疗当中具有优势，提高了术中定位的精准度，可减少术中造影剂用量、操作时间及术中造影次数，降低主动脉相关再干预风险和并发症的发生率。

关键词: 主动脉腔内修复术；3D导航；术中平板CT

Abstract: Objective:To evaluate the feasibility and technical advantages of 3D guidance technique in endovascular aortic repair.Methods:This was a retrospective single center study.From November 2016 to December 2018，38 patients undergoing thoracic endovascular aortic repair（TEVAR）or endovascular aortic repair（EVAR）with assistance of 3D guidance technique and intraoperative DynaCT.Meanwhile，40 patients were received standard endovascular aortic repair（control group）.The proximal anchorage area was insufficient for branch vascular reconstruction in 16 patients.Comparative analysis of intraoperative and followup data between the two groups was undertaken.Results:The results of this study showed that compared with conventional DSA，3D guidance technique and intraoperative DynaCT reduced contrast dose（TEVAR 60.31ml vs 73.34ml P=0.032；EVAR 83.43ml vs 94.83ml P=0.013），intraoperative radiation dose（TEVAR 293.04mGy vs 385.71mGy P=0.002；EVAR 431.84mGy vs 584.51mGy，P=0.043），number of radiography（TEVAR 2.36 vs 3.56，P=0.016；EVAR 3.43 vs 4.01，P=0.029），operation time（TEVAR 64.09min vs 71.42min P=0.001；EVAR 142.14min vs 153.39min P=0.057），meanwhile，reduced the risk of postoperative aortarelated reintervention（2.63% vs 10% P=0.042），meeting the precise requirements for anatomical positioning and immediate effect determination during endovascular aortic repair.Conclusion:3D guidance technique improves the accuracy during positioning in complex endovascular aortic repair，could reduce aorticrelated reintervention rate，radiation exposure time and contrast dose.Further studies and development are needed to obtain optimal image quality and higher precision.

Key words: endovascular aortic repair, 3D guidance, DynaCT

方坤, 罗明尧, 赵嘉伟, 薛云飞, 舒畅. 3D导航技术在主动脉腔内修复术中的应用[J]. 临床外科杂志, 2019, 27(11): 938-942.

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