Observation of 3D printing-assisted individualized composite covered stent in Stanford type A aortic dissection
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摘要: 目的 研究3D打印辅助的个体化组合覆膜支架在Stanford A型主动脉夹层中应用的效果，并与同期行孙氏手术病例进行对照比较。方法 回顾分析2017年9月—2021年10月我院确诊的Stanford A型主动脉夹层外科治疗的资料，研究组3D打印辅助的个体化组合覆膜支架辅助手术20例，对照组孙氏手术20例，比较两组的临床结果。结果 两组术中均无死亡病例，3D打印辅助的个体化组合支架组，体外循环时间(CPB)[(165.05±31.6) min vs(223±33.5) min，P < 0.05]，术中深低温停循环时间[(10.15±5.3) min vs(18.95±3.6) min，P < 0.05]，主动脉阻断时间[(121.08±22.6) min vs(164.10±25.8) min，P < 0.05]，术后24 h引流量[(550±230.5) mL vs(770±220.8) mL，P < 0.05]，术后呼吸机辅助呼吸时间[(36±4.6) h vs(58.6±6.8) h，P < 0.05]，ICU住留时间比较[(6.4±1.6) d vs(9.5±2.1) d，P < 0.05]，差异有统计学意义，术后神经系统并发症发生率(30% vs 45%)、术后低氧血症发生率(20% vs 40%)优于对照组。术后1个月内，两组各有2例自动出院。其余病例术后随访1年，左室射血分数、主动脉最大内径无明显差异，研究组内漏的发生率较对照组高(16.7% vs 5.5%)。结论 3D打印辅助的个体化组合支架组体外循环时间、深低温停循环时间、主动脉阻断时间、ICU住留时间优于孙氏手术，有良好的近期临床效果，术后近期并发症少于孙氏手术，但术后随访远期内漏的发生率较孙氏手术高。Abstract: Objective To research the effect of 3D printing-assisted individual composite covered stent in Stanford type A aortic dissection and compare it with simultaneous operation of Sun's operation.Methods From September 2017 to Qctober 2021, 20 patients with Type A aortic dissection were enrolled in this study, and another 20 cases in Sun's operation. The clinical outcomes were compared between the two groups.Results There was no death case in both groups during operation. In the 3D printing assisted individualized composite stent group, cardiopulmonary bypass(CPB) [(165.05±31.6) min vs(223±33.5) min, P < 0.05], the time of deep hypothermia circulatory arrest during operation[(10.15±5.3) min vs(18.95±3.6) min, P < 0.05], the time of aortic occlusion[(121.08±22.6) min vs(164.10±25.8) min, P < 0.05], the drainage volume 24 hours after operation[(550±230.5) mL vs(770±220.8) mL, P < 0.05], The time of ventilator assisted respiration after operation[(36±4.6) h vs(58.6±6.8) h, P < 0.05], and the time of ICU stay[(6.4±1.6) d vs(9.5±2.1) d, P < 0.05]were statistically significant. The incidence of postoperative neurological complications(30% vs 45%), and the incidence of postoperative hypoxemia(20% vs 40%) were better than those in the control group. Within one month after operation, 2 patients in each group gave up treatment. The other cases were followed up for 1 year after operation. There was no significant difference in left ventricular ejection fraction and the maximum diameter of aorta(P>0.05). The incidence of internal leakage in the study group(16.7% vs 5.5%) was higher than that in the control group.Conclusion The time of CPB, deep hypothermic circulatory arrest, aortic cross-clamping, the time of ICU stay and postoperative complications in the 3D printing-assisted individualized stent group were better than those in the Sun's operation. With good short-term clinical results, the short-term postoperative complications were less than those of Sun's operation, but the incidence of postoperative in forward period endoleak was higher than that of Sun's operation.
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Key words:
- individualized composite stent /
- type A aortic dissection /
- 3D printing
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表 1 术前患者的情况
Table 1. General data
例(%), X±S 项目 研究组(20例) 对照组(20例) 年龄/岁 48.8±10.1 50.2±9.6 男性 12(60) 16(80) 高血压 18(90) 16(80) 发病至手术时间/h 8.2±1.6 7.9±1.8 谷丙转氨酶/(U/L) 65.6±11.3 68.7±10.5 总胆红素/(μmol/L) 35.8±10.6 33.6±11.1 高敏肌钙蛋白/(pg/mL) 23.4±9.8 24.4±8.6 血肌酐/(μmol/L) 51.6±11.4 53.6±10.6 左室射血分数/% 53.5±4.5 52.8±3.8 心包积液 8(40) 7(35) 主动脉瓣中度以上关闭不全 14(70) 16(80) 
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表 2 术中及术后监护情况
Table 2. Intraoperative and postoperative data
例(%), X±S 项目 研究组(20例) 对照组(20例) 体外循环时间/min 165.1±31.61) 223.0±33.5 停循环时间/min 10.2±5.31) 18.9±3.6 心肌阻断时间/min 121.1±22.61) 164.1±25.8 术后24 h引流量/mL 550.0±230.51) 770.0±220.8 术后神经系统并发症 6(30)1) 9(45) 术后辅助呼吸时间/h 36.0±4.61) 58.6±6.8 术后低氧血症 4(20)1) 8(40) 术后ICU住留时间/d 6.4±1.61) 9.5±2.1 与对照组比较，1)P < 0.05。
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表 3 术后随访情况
Table 3. Postoperative follow-up
例(%), X±S 项目 研究组(18例) 对照组(18例) 术后3个月左室射血分数/% 53.6±6.5 52.8±3.8 术后3个月胸主动脉最大内径/mm 30.2±2.8 31.4±1.9 术后1年内漏 3(16.7)1) 1(5.5) 血压控制满意率 17(94.0) 18(100.0) 与对照组比较，1)P < 0.05。
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