本文選題：胸腹主動脈瘤 + 多層裸支架��； 參考：《第二軍醫(yī)大學(xué)》2017年碩士論文

【摘要】：研究背景胸腹主動脈瘤(Thoracoabdominal aortic aneurysm,TAAA)常累及腹腔干動脈、腸系膜上動脈、腎動脈等重要分支動脈,外科手術(shù)難度大,目前仍沒有公認(rèn)的標(biāo)準(zhǔn)術(shù)式。傳統(tǒng)開放手術(shù)需要聯(lián)合開胸開腹,阻斷并重建內(nèi)臟動脈血供,手術(shù)創(chuàng)傷大,部分患者無法耐受。開窗、分支型支架以及煙囪技術(shù)等主動脈腔內(nèi)修復(fù)術(shù)(Endovascular aortic repair,EVAR)具有明顯的微創(chuàng)優(yōu)勢,減少了內(nèi)臟缺血及脊髓并發(fā)癥。但面臨定制周期長、術(shù)中需要使用大劑量造影劑、內(nèi)漏并發(fā)癥高及手術(shù)費用大等劣勢。在此背景下國內(nèi)外嘗試應(yīng)用多層裸支架技術(shù)治療累及重要分支動脈的復(fù)雜動脈瘤。初期結(jié)果,令人鼓舞。然而中長期臨床隨訪發(fā)現(xiàn)有動脈瘤破裂及重要分支堵塞等嚴(yán)重并發(fā)癥發(fā)生。研究目的探討新型多層裸支架治療胸腹主動脈瘤的臨床可行性。本研究從血液動力學(xué)基本原理入手,并根據(jù)前期研究結(jié)果(裸支架孔隙率、滲透性)對裸支架血液動力學(xué)效應(yīng)的影響,結(jié)合目前臨床應(yīng)用裸支架的缺點自主研發(fā)設(shè)計應(yīng)用于胸腹主動脈瘤的新型裸支架腔內(nèi)移植物。隨后通過計算機模擬新型裸支架在胸腹主動脈瘤個體化3D模型中釋放,觀察其瘤腔內(nèi)血液動力學(xué)變化,最后通過動物實驗初步評估新型多層裸支架治療胸腹主動脈瘤的安全性及有效性。研究方法1.根據(jù)新型裸支架的結(jié)構(gòu)特征(螺旋直徑、螺旋角度、線徑長短、線徑粗細(xì)等)構(gòu)建新型多層裸支架的計算機模型。2.利用3D Slicer 4.5.0-1及血管建模工具包(The Vascular Modeling Toolkit,VMTK)構(gòu)建胸腹主動脈瘤患者個體化3D動脈瘤模型。3.計算機模擬支架置入并分析新型多層裸支架置入后瘤腔內(nèi)血液動力學(xué)變化:分析內(nèi)容包括瘤腔內(nèi)的管壁應(yīng)力、血流流速以及管壁切應(yīng)力等參數(shù)。4.建立一種形態(tài)學(xué)及血液動力學(xué)與累及分支動脈的復(fù)雜胸腹主動脈瘤相似,適用于新型多層裸支架研究的動物模型。5.將新型裸支架置入動物模型中,隨訪3個月復(fù)查CTA觀察動脈瘤直徑變化、瘤腔內(nèi)血栓率變化及分支動脈通暢情況。研究結(jié)果1.計算機模擬新型裸支架置入個體化3D動脈瘤,顯著增加瘤頸接觸處的管壁應(yīng)力,而瘤腔內(nèi)壁的應(yīng)力無明顯變化;瘤腔內(nèi)流速及切應(yīng)力顯著減低。2.建立動物模型18例,1例因麻醉過深死于呼吸抑制;2例術(shù)后發(fā)現(xiàn)分支動脈閉塞;其余15例均成功并且動物模型與臨床胸腹主動脈瘤在形態(tài)和血液動力學(xué)上相似。3.動物模型置入新型裸支架后引起動脈瘤最大直徑減小(15.8±0.7mm降低至15.3±0.9 mm)、誘導(dǎo)瘤腔內(nèi)血栓進(jìn)一步形成(12.6±4.2%增加至52.7±15.4%,p0.001)并保持分支動脈通暢(93.3%,14/15),達(dá)到治療動脈瘤預(yù)期效果。結(jié)論新型多層裸支架引起瘤腔內(nèi)血液動力學(xué)變化,降低瘤腔內(nèi)血流速度和瘤壁切應(yīng)力,在保持分支動脈通暢的同時誘導(dǎo)瘤腔內(nèi)血栓形成,增加管壁有效厚度從而降低管壁應(yīng)力,達(dá)到治療效果。為累及分支動脈的胸腹主動脈瘤的腔內(nèi)治療提供了一種新的腔內(nèi)移植物選擇。同時新型多層裸支架治療胸腹主動脈瘤的有效性、安全性有待于大規(guī)模體外、動物實驗進(jìn)一步的驗證。
[Abstract]:Background Thoracoabdominal aortic aneurysm (TAAA) often involves an important branch of the abdominal dry artery, the superior mesenteric artery, and the renal artery. The surgical operation is difficult and there are still no recognized standard surgical procedures. Traditional open surgery requires open thoracotomy, blocking and reconstructing the blood supply of the visceral arteries. The surgical trauma is large. Endovascular aortic repair (EVAR), such as window opening, branching stents and chimney technology, has obvious minimally invasive advantages to reduce visceral ischemia and spinal cord complications. However, large dose contrast agents, high internal leakage complications and large surgical costs are needed during the long period of customization. In this context, it is an attempt to treat complicated aneurysms involving important branch arteries at home and abroad. Early results are encouraging. However, in the middle and long term clinical follow-up, severe complications such as aneurysm rupture and important branch blockage are found. This study is based on the basic principle of hemodynamics, and based on the effect of the previous study on the hemodynamic effect of bare stents, combined with the shortcomings of the present clinical application of bare scaffolds in the design of a new type of bare stent graft applied to the thoracic and abdominal aortic aneurysm. A new type of bare scaffold was released in the individualized 3D model of thoracic and abdominal aortic aneurysm, and the hemodynamic changes were observed in the aneurysm. Finally, the safety and effectiveness of the new type multi-layer bare stent in the treatment of thoracic and abdominal aortic aneurysm were evaluated by animal experiments. 1. according to the structural characteristics of the new naked support (spiral diameter, spiral angle, and line) A computer model of a new type of multilayer bare scaffold.2. is constructed by using 3D Slicer 4.5.0-1 and vascular modeling toolkit (The Vascular Modeling Toolkit, VMTK) to construct the individualized 3D artery aneurysm model for patients with thoracic and abdominal aortic aneurysm. Dynamic changes: the analysis includes the tube wall stress, flow velocity, and tube wall shear stress and other parameters.4. to establish a kind of morphological and hemodynamics similar to the complicated thoracic and abdominal aortic aneurysm involving the branch artery, which is suitable for the new type of bare scaffold model.5. to put new bare stents into the animal model and follow up 3 The changes in the diameter of the aneurysm, the change of thrombus rate in the lumen and the patency of the branch artery were observed at CTA months. Results 1. computer simulation of a new type of bare scaffold was implanted into the individual 3D aneurysm, which significantly increased the stress of the tube wall at the neck contact, but the stress of the inner wall of the tumor had no obvious change; the velocity of the tumor and the shear stress in the lumen were significantly reduced by.2.. Animal model 18 cases, 1 patients died of respiratory depression over deep anesthesia, 2 cases were found branch artery occlusion, the other 15 cases were successful and the animal model and Clinical Thoracic and abdominal aortic aneurysm resemble the shape and hemodynamics of.3. animal model after implantation of new bare scaffold to cause the largest diameter of aneurysm (15.8 + 0.7mm to 15.3 + 0.9 mm). The intravascular thrombus was further induced (12.6 + 4.2% to 52.7 + 15.4%, p0.001) and the branch patency (93.3%, 14/15) was maintained to achieve the expected effect of the aneurysm. Conclusion a new type of multi-layer bare stent was used to induce hemodynamic changes in the lumen of the tumor, to reduce the blood flow velocity and wall shear stress in the lumen, and to induce the patency of the branch artery at the same time. A new endovascular graft selection is provided for the intracavitary treatment of thoracic and abdominal aortic aneurysm involving branching arteries. The safety of new type multi-layer bare stents for the treatment of thoracic and abdominal aortic aneurysm needs to be safe in vitro and in vitro. The experiment is further verified.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R543.16

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相關(guān)期刊論文 前1條

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本文編號：2026106