Stanford B型主动脉夹层介入腔内隔绝治疗前主动脉3D打印模型的指导作用

doi:10.3969/j.issn.1006-5725.2024.12.007

Abstract

Abstract:

Objective To investigate the role of preoperative 3D printing simulation technology in the interventional endovascular exclusion of Stanford B aortic dissection. Methods A retrospective study protocol was used to select 76 patients with Stanford B-type aortic dissection who underwent endovascular isolation surgery in our hospital from January 2019 to January 2021 in the study. Among them， 40 patients underwent simulated surgery with preoperative 3D printing simulation technology （simulation group） and another 36 patients received conventional endovascular isolation surgery （control group）. The two groups were compared in terms of the.cardiac ultrasound indicators， the true and false lumen diameters， and the complication rates of the proximal aortic rupture plane， stent end plane， and abdominal trunk artery plane at different times before and after surgery. Results As compared to the control group， the simulation group showed significantly longer surgical time， extracorporeal circulation time， aortic occlusion time， and ICU stay time （all P < 0.05）. After the operation， the true lumen diameter of the proximal aortic rupture plane， stent end plane， and abdominal trunk artery plane were significantly increased in two groups at months 1， 3， and 6 （P < 0.05）， but the false lumen diameter of the proximal aortic rupture plane， stent end plane， and abdominal trunk artery plane were significantly decreased （P < 0.05） compared to preoperative levels. The LVEF and FS of the two groups were significantly increased 6 months after surgery （P < 0.05）. Conclusion The preoperative 3D printing simulation technology in the interventional endovascular isolation of Stanford B aortic dissection can ensure the surgical effect. It can achieve the same surgical effect as the traditional procedures and importantly it can reduce the difficulty of operation and shorten the operation time.

Key words: 3D printing technology, Stanford B, aortic dissection, interventional therapy, intraluminal isolation surgery, cardiac ultrasound

CLC Number:

R543.1

Yancun ZHENG,Zhu DONG,Jinli LIN,Xiaowu WANG. The role of 3D printing technology in the preoperative interventional endovascular exclusion of Stanford B aortic dissection[J]. The Journal of Practical Medicine, 2024, 40(12): 1651-1658.

Figures/Tables 12

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References 25

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组别	例数	年龄（x ± s，岁）	性别		高血压	糖尿病	高血脂	冠心病
组别	例数	年龄（x ± s，岁）	男	女	高血压	糖尿病	高血脂	冠心病
模拟组	40	62.9 ± 7.1	30（75.00）	10（25.00）	21（52.50）	12（30.00）	29（72.50）	9（22.50）
对照组	36	64.5 ± 8.2	30（83.33）	6（16.67）	25（69.44）	16（44.44）	22（61.11）	4（11.11）
t/χ ² 值		-0.912	0.792		2.277	1.97	0.798	1.597
P值		0.365	0.314		0.131	0.16	0.372	0.206

组别	例数	BMI（x ± s，kg/m²）	NYHA分级		胸痛	胸闷	吸烟	饮酒
组别	例数	BMI（x ± s，kg/m²）	≤Ⅱ级	> 级	胸痛	胸闷	吸烟	饮酒
模拟组	40	23.38 ± 1.80	29（72.50）	11（27.50）	38（95.00）	35（87.50）	21（52.50）	17（42.05）
对照组	36	23.72 ± 1.92	31（86.11）	5（13.89）	35（97.22）	30（83.33）	17（47.22）	12（33.33）
t/χ ² 值		-0.797	2.112		0.247	0.052	0.115	0.675
P值		0.428	0.146		0.619	0.82	0.734	0.411

组别	例数	手术时间（min）	体外循环时间（min）	主动脉阻断时间（min）	手术出血量（mL）	术后气管插管时间（h）	ICU停留时间（h）
模拟组	40	418.9 ± 67.8	224.6 ± 38.1	158.3 ± 22.0	784.8 ± 201.9	45.9 ± 9.4	92.8 ± 17.5
对照组	36	453.0 ± 72.4	247.3 ± 41.0	172.0 ± 24.3	811.3 ± 224.7	48.0 ± 11.2	103.6 ± 19.8
t值		-2.120	-2.502	-2.580	-0.542	-0.888	-2.524
P值		0.037	0.015	0.012	0.590	0.377	0.014

指标	组别	术前	术后1个月	术后3个月	术后6个月
主动脉近端破口平面真腔内径	模拟组（n = 40）	19.8 ± 3.6	32.7 ± 5.6^*	38.5 ± 5.9^*	41.0 ± 5.5^*
主动脉近端破口平面真腔内径	对照组（n = 36）	20.5 ± 3.3	31.5 ± 5.5^*	36.4 ± 5.2^*	40.2 ± 4.8^*
		F_组间 = 0.910、F_时间 = 74.201、F_{组间×时间} = 15.582
		P_组间 = 0.401、P_时间 = 0.000、P_{组间×时间} = 0.000
主动脉支架末端平面真腔内径	模拟组（n = 40）	18.5 ± 4.0	24.5 ± 4.7^*	28.3 ± 3.8^*	30.5 ± 3.5^*
主动脉支架末端平面真腔内径	对照组（n = 36）	17.8 ± 3.3	22.6 ± 3.5^*	26.9 ± 4.2^*	29.6 ± 4.1^*
		F_组间 = 1.104、F_时间 = 48.662、F_{组间×时间} = 12.039
		P_组间 = 0.386、P_时间 = 0.000、P_{组间×时间} = 0.000
腹腔干动脉平面真腔内径	模拟组（n = 40）	11.3 ± 2.5	13.2 ± 2.0^*	15.4 ± 2.2^*	15.5 ± 2.0^*
腹腔干动脉平面真腔内径	对照组（n = 36）	10.8 ± 2.2	12.8 ± 2.1^*	14.9 ± 2.3^*	15.1 ± 2.2^*
		F_组间 = 1.361、F_时间 = 14.209、F_{组间×时间} = 3.206
		P_组间 = 0.322、P_时间 = 0.000、P_{组间×时间} = 0.720

指标	组别	术前	术后1个月	术后3个月	术后6个月
主动脉近端破口平面假腔内径	模拟组（n = 40）	20.7 ± 2.5	11.3 ± 2.2^*	10.1 ± 1.8^*	7.4 ± 1.2^*
主动脉近端破口平面假腔内径	对照组（n = 36）	21.9 ± 3.3	13.0 ± 2.4^*	11.6 ± 2.2^*	8.2 ± 1.8^*
		F_组间 = 2.019、F_时间 = 55.400、F_{组间×时间} = 14.293
		P_组间 = 0.183、P_时间 = 0.000、P_{组间×时间} = 0.000
主动脉支架末端平面假腔内径	模拟组（n = 40）	21.7 ± 3.3	14.6 ± 3.0^*	12.9 ± 2.5^*	8.5 ± 1.4^*
主动脉支架末端平面假腔内径	对照组（n = 36）	21.0 ± 2.9	16.2 ± 2.8^*	14.0 ± 2.7^*	9.8 ± 1.7^*
		F_组间 = 2.271、F_时间 = 51.920、F_{组间×时间} = 15.514
		P_组间 = 0.166、P_时间 = 0.000、P_{组间×时间} = 0.000
腹腔干动脉平面假腔内径	模拟组（n = 40）	18.6 ± 2.7	17.2 ± 2.2^*	16.6 ± 1.9^*	15.3 ± 2.3^*
腹腔干动脉平面假腔内径	对照组（n = 36）	19.1 ± 2.8	17.8 ± 1.9^*	17.4 ± 2.1^*	15.9 ± 2.4^*
		F_组间 = 1.535、F_时间 = 13.352、F_{组间×时间} = 2.961
		P_组间 = 0.310、P_时间 = 0.000、P_{组间×时间} = 0.104

组别	例数	LVEF（%）		t值	P值	LVEDd（mm）		t值	P值	FS（%）		t值	P值
组别	例数	术前	术后6个月	t值	P值	术前	术后6个月	t值	P值	术前	术后6个月	t值	P值
模拟组	40	53.9 ± 5.4	60.3 ± 4.8	-5.436	0.000	50.8 ± 4.1	48.9 ± 4.5	1.926	0.058	26.5 ± 2.9	30.5 ± 3.4	-5.534	0.000
对照组	36	52.5 ± 4.8	58.8 ± 5.1	-5.547	0.000	52.1 ± 3.8	50.0 ± 4.8	1.518	0.133	27.4 ± 3.2	31.2 ± 3.8	-4.731	0.000
t值		1.189	1.321			-1.429	-1.593			-1.286	-0.848
P值		0.238	0.191			0.157	0.115			0.202	0.399

The role of 3D printing technology in the preoperative interventional endovascular exclusion of Stanford B aortic dissection

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组别	例数	Ⅰ型内漏	脑梗死	肾功能损伤	胸腔积液	合计
模拟组	40	1	1	3	2	7（17.5）
对照组	36	2	1	3	3	9（25.0）
χ²值						3.287
P值						0.07

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