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科技赋能,助推主动脉外科新时代高速发展

Technological innovation spurs high-speed advancement of aortic surgery in new era

来源期刊: 广州医药 | 1-8 发布时间:2026-01-20 收稿时间:2026/2/6 11:36:15 阅读量:36
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关键词:
主动脉外科手术技术科技创新精准医学
aortic surgerysurgical techniquescience and technique innovationprecision medicine
DOI:
10. 20223 / j. cnki. 1000-8535. 2026. 01. 001
收稿时间:
2025-03-03 
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0  
       主动脉外科已走过70年的辉煌岁月,现有诊疗体系已基本解决“挽救患者生命”的重要时代议题。如今,新一轮科技革命悄然来临,我国主动脉外科广大同仁应主动转变以“量”取胜的传统观念,寻找学科内容不足,明确诊疗环节短板,提炼问题底层逻辑,以“质”换空间,扩展学科边界。学科发展更应秉持开放包容之心态,坚持守正创新之原则,借助不同学科技术优势,努力解决目前诊疗活动各环节中仍存在的问题及争议点,为我国广大人民群众提供精细化的诊疗服务。

       For the past 70 years of aortic surgery,the current diagnosis and treatment strategies have generally solved the important issue of “saving lives”.Nowadays,the new scientific and technological revolution is coming.The practitioners in aortic surgery should change the traditional perception and look for the insufficiency and the shortcomings of diagnosis and treatment,which finally expand the boundaries of the discipline.Moreover,the discipline development shall be more open-minded and persist in innovation.We should take the advantages of different discipline technologies,and strive to solve the current issues and controversies remaining in diagnosis and treatment toward providing refined services for the public.
       朱俊明   首都医科大学附属北京安贞医院成人心脏外科中心主任、主动脉外科中心主任,医学博士,主任医师,国家二级教授,首都医科大学博士生导师,博士后合作导师。享受国务院特殊津贴专家,北京市战略科技人才,首都医科大学附属北京安贞医院心脏外科中心主任,首都医科大学主动脉疾病临床诊疗和研究中心副主任,任中国医师协会心血管外科医师分会会长、全国大血管外科专业委员会主任委员、中国医药生物技术协会心血管外科技术与工程分会主任委员、北京医学会心脏外科学分会主任委员等多项学术职务。任美国AATS协会及欧洲EACTS协会会员、中华医学会评审专家、中华医学科技奖评审专家、教育部科技司专家库专家。担任《中国循证心血管医学杂志》通讯编委,《中华胸心血管外科杂志》《中华临床医师杂志(电子版)》《中国心血管病研究》等多个专业期刊编委。
       在任期间,首都医科大学附属北京安贞医院主动脉外科中心完成主动脉外科手术及介入手术超过1 500余例/年。其中,胸腹主动脉替换术>100例/年。完成世界最大妊娠合并主动脉夹层和颈位弓的队列研究。获国家技术发明三等奖1项,国家科技进步奖二等奖2项,国家教育部科学技术进步奖一等奖1项,中华医学科技奖一等奖2项、三等奖1项,北京市科技进步二等奖2项、三等奖1项,华夏医学科技奖一等奖1项。中国医师协会心血管外科优秀医师奖(金刀奖),金柳叶刀奖获得者。
       目前主持参与国家科技重大专项、国家重点研发、国家自然科学基金等国家及省部级课题18项,参与发表主动脉疾病的临床诊疗技术与发病机制研究SCI论文134篇,相关成果被多部国际专著及指南引用。获国家发明和实用新型专利13项。主编参编专业专著4部。牵头制定、参与发布国内国际诊疗规范及共识9部。


       上世纪50年代,Debakey和Cooley教授破除“比尔罗特魔咒”,开启主动脉外科的黄金时代。我国众多主动脉外科前辈面对人才匮乏、经验缺失,医疗器械、缝线短缺等困境,攻克“夜战、苦战、血战”等诸多难题,完成了从落后到追赶、变被动为主动的时代使命。时至今日,主动脉外科已建立完整的诊疗体系和管理策略,死亡率早已不是困扰国内外医者的梦魇,但医疗活动各环节仍存在诸多争议与证据空白。近年来,开放与腔内手术技术不断革新,人工智能、分子影像、分子生物、流体及生物力学等学科蓬勃发展,主动脉外科专科医师应建立多维研究理念,博采众长,全面推动学科高质量发展。本文将重点归纳当前主动脉外科领域的前沿热点及成果,简要梳理学科短板与未来发展方向。

1  主动脉外科诊疗策略及手术技术

1.1 复杂主动脉疾病的“中国方案”

       随着常见主动脉疾病诊疗结果不断改善,主动脉疾病谱逐渐向高龄、合并症多、既往病史复杂、合并脏器灌注不良或解剖畸形等各类复杂主动脉疾病转变。我国学者在这方面做出了突出的贡献。北京安贞医院主动脉外科团队基于有无血管环和主动脉弓与降主动脉毗邻关系制定了颈位主动脉弓简化分型,并发表了35例短长期外科治疗,结果显示,应用该简化分型制定的手术策略实现了围术期零死亡、脊髓损伤零发生及7年总生存率100%的优异效果。该分型突破了传统分型临床实用性不足及覆盖面不全的问题,为罕见主动脉疾病的精准化诊疗提供新的框架[1]
       北京安贞医院多学科团队针对妊娠合并主动脉夹层(aortic dissection,AD)制定了基于AD类型和孕周指定的多学科综合管理策略,将此类高危疾病的母亲死亡率降低50%,胎儿死亡率降低20%[2-3]。由于治疗结果优异,其管理策略被2022年美国心脏协会/美国心脏病学会发布的《主动脉疾病诊断与治疗指南》引用推荐[4]。其团队在2024年美国胸外科协会和2024年欧洲胸心外科协会年会上分别汇报了最新治疗结果(未发表)。其中,A型AD母胎总生存率分别为90%和71%,B型AD母胎总生存率分别为93.3%和70%。
       孙立忠教授于2016年提出主动脉-髂动脉辅助转流术中管理胸腹主动脉瘤(thoracoabdominal aortic aneurysm,TAAA),通过优先重建远端脏器血流实现脏器保护,实现围术期患者零死亡,术后肾功能不全发生率仅3.6%,脊髓保护效果和传统体外循环辅助技术相近[5-6]。近些年来,北京安贞医院已掌握股动静脉转流和左心转流等辅助技术,标志着我国实现了主动脉疾病“全生命周期”外科治疗的实力。另一方面,全腔内修复技术则成为不能耐受开放手术患者的替代方式。加拿大多中心研究显示,高龄TAAA患者(>80岁)全腔内治疗的短期预后优于开放手术,但术后5年再次干预率仍超20%[7]。Debus等[8-9]开发了用于治疗TAAA的杂交支架,在保证脊髓血供的同时,将分支血管缺血时间缩短到10分钟。该支架目前仍处于动物实验阶段,临床安全性和有效性仍需要进一步证实。
       A型AD合并脏器灌注不良是影响预后的重要因素,其最佳诊疗策略应该是灌注不良优先还是主动脉修复优先一直是国际研究的重中之重。我国吴锡阶教授团队以脏器灌注不良发生6小时为阈值,为国际提供了以灌注不良时间为导向的外科治疗策略,将灌注不良的AD患者院内死亡率从33.9%降至10.2%,手术死亡率降至4.0%[10]

1.2 外科手术技术持续革新

       支架象鼻技术(stented elephant trunk,SET)可以有效封堵原发破口、扩展真腔、促进假腔重塑。北京安贞医院采用中低温停循环联合单侧顺行性脑灌注(unilateral selective antegrade cerebral perfusion,uSACP)开展孙氏手术,结果显示其与部分主动脉弓置换术围术期结果相近,但远期效果更优异[11-12]。根据《主动脉夹层诊断与治疗规范中国专家共识》,uSACP可兼顾绝大多数A型AD的手术安全性和操作简便性[13]。但最新随机对照研究结果证实,非生理性低温均对脑结构/功能造成损伤[14]。因此,一些学者尝试通过改变远端吻合或阻断方式缩短/避免停循环,具有代表性的包括:球囊内阻断[5]、支架血管外阻断[15]、三分支支架血管[16]、新型无缝线集成支架血管[17-18]和远端血管切割吻合器[19-20]等。上述技术改进将停循环时间控制在10分钟内,其中支架血管外阻断技术甚至将停循环时间控制在3分钟内。另外一些学者尝试改变体-脑循环灌注方式提高核心温度,浅低温(≥28℃)停循环的安全性得到了有效验证[21-22],在不增加手术死亡率的同时,将主要不良事件发生率降低5倍,ICU平均停留时间缩短到16.7小时。未来应重点证明浅低温技术的安全性及有效性,尤其是其对重要脏器保护的价值,进一步确定浅低温的最佳温度。

1.3 根部技术新证据与技术改进

       主动脉根部几何结构复杂,如实施主动脉瓣膜修复术,术者需在适应症选择、几何纠正、组织处理等核心原则之间达到精细平衡。David手术保留自体主动脉瓣,避免长期抗凝产生的出血或人工瓣膜毁损风险。但手术技术复杂,学习曲线较长,缺乏长期安全性证据,该术式仍在我国未得到广泛应用。克利夫兰诊所和多伦多总医院的长期研究结果证明,David术后15年无需再干预率95%,8.5%的马方综合征患者在术后20年内出现中重度主动脉瓣关闭不全[23-24]
       主动脉瓣置换的核心在于“匹配”与“平衡”。Nicks、Manouguian等术式扩大主动脉瓣环能力有限,难以满足临床需求。密歇根大学杨波教授提出Y形切口主动脉瓣环扩大术,将主动脉瓣环直径扩大6~8 mm(较传统术式提高40%~60%),平均跨瓣压差下降5倍,仅5.5%的患者术后出现中度瓣膜不匹配的情况[25-26]。Y形切口主动脉瓣环扩大术可植入更大的人工瓣膜,显著改善血流动力学(EOAI达标率>95%)。考虑到远期因人工生物瓣衰败行“瓣中瓣”介入修复的可能,有效扩大的瓣环还降低了介入修复后瓣膜不匹配的风险,实现终生管理的愿景[27]。该技术适合复杂性小根部病变,但对术者经验要求较高,长期耐久性及广泛推广仍需更大样本量研究验证。

1.4 腔内修复技术持续改进创新

       随着腔内修复技术的蓬勃发展,国内外学者开始尝试应用腔内技术修复主动脉根部病变。Rylski教授早在2014年就提出“Endo-Bentall”理念,但冠状动脉开口解剖适配性和装置稳定性欠佳,限制其临床转化[28]。郭伟教授在2023年提出模块支架系统,解剖适用性达66.4%,解决了其泛用性的问题[29]。法国学者设计了开窗和分支两种Endo-Bentall技术方案,解剖适用性分别提高至69.8%和73.3%[30]。然而,Endo-Bentall目前仍处于临床初期应用阶段,应开展前瞻性研究或随机对照试验来验证其安全性和有效性,确定其技术使用人群和技术边界。
       原位开窗和平行支架技术是两种较早应用于临床的腔内修复技术。原位开窗技术操作时头臂血管会经历一段时间的缺血,术后脑卒中发生率约6%;平行支架技术中头臂血管分支支架和主体支架间贴合不佳导致术后内漏发生率高(9%)[31–33]国内外学者尝试开发模块化设计的分支支架系统来弥补既往技术的局限性,比如NEXUS®支架系[34]、ZIPPER®支架系统[35]和陆清声教授团队开发的三分支覆膜支架[36]。此外,韩国学者研发模块化冷冻象鼻支架,可根据患者疾病特点实施定制手术[37]。上述新兴支架系统为处理主动脉弓部病变提供了全新治疗手段,但仍需更多研究提供可靠性证据。

2  技术交叉融合探索学科难题

2.1 分子影像学

       正电子发射计算机断层显像(positron emission tomography computed tomography,PET-CT)在主动脉疾病的核心价值在于捕捉主动脉管壁炎症与钙化等微观生物学异常,避免解剖结构改变等急性病程发生。Nakahara等[38]的动物实验显示,腹主动脉扩张与18F-FDG、18F-NaF摄取及钙化体积有良好的相关性,其中18F-NaF摄取是最强预测因子(r=0.80,P<0.001;多元线性回归β=0.74,P=0.022)。Syed等[39]回顾性研究显示,AD内膜破口处的18F-NaF摄取显著增强,与主动脉扩张和不良结局独立相关。另外,随着免疫与炎症机制的深入研究,诸如68Ga标记的奥曲肽[40]和64Cu标记的纳米抗体[41]等靶向血管炎症反应与巨噬细胞活性的新型探针也在临床试验当中。虽然PET-CT仍受限于分辨率不足、辐射暴露和检查费用昂贵等,但其将成为精准医学时代不可或缺的组成部分。
       四维核磁共振成像(four-dimensional magnetic resonance imaging,4D-flow)可同时获取形态结构和定性定量的流体及生物力学参数[42-43]Ramaekers等[44]通过4D-flow技术采集全心动周期主动脉血流,揭示涡度与螺旋度峰值显著滞后于流量峰值的时间特性,推动主动脉流场定量研究向多维度深化。Urmeneta等[45]利用4D-flow技术定量评估AD手术前后真假腔体积、流量、压力以及血流沟通模式;Zeng等[46]发现了胸腹主动脉病变的主动脉高脉搏波速度、高返流分数、低峰值速度等特点。此外,4D-flow在探索风险分层指标[47-48]评估手术远期结果[49–51]等方面亦有着诸多进展。随着技术迭代,4D-flow刻画整体主动脉流场的能力将进一步趋近于真实,有助于优化临床决策和预测疾病转归。

2.2 人工智能辅助决策系统日渐成熟

       人工智能(artificial intelligence,AI)在疾病
筛查、预测疾病进展与预后等方面都展示出强大的优越性。浙江中医药大学团队应用AI实现基于CT平扫筛查AD的模型,其敏感度达85.7%,特异度达91.7%[52];美国学者利用影像组学相关指标训练的AI模型预测主动脉瘤进展风险效能也优于传统临床指标[53];武汉大学人民医院团队研究发现,AI预测腔内治疗后不良事件的准确度和精确度均高达92%[54];此外,加拿大胸主动脉协作组利用AI术前评估风险最低的脏器保护策略,制定有效的个体化术中管理策略[55]。AI模型的可靠性和鲁棒性仍需更多大样本和不同中心的数据验证,但不应怀疑AI辅助决策系统将是未来主动脉外科临床工作的重要工具。

2.3 靶向药物与再生医学披荆斩棘

       靶向药物具有兼顾早期诊断与早期干预的特性。Xu等[56]开发了含钆多功能纳米系统,递送治疗性核酸稳定血管壁结构;Ji等[57]通过纳米技术将细胞因子靶向递送至病变部位,实现稳定血管壁、降低AD发病风险的效果,为主动脉疾病诊疗一体化提供了新的策略。目前,仍有很多具有极大潜力的靶向药物,如基于单细胞测序发现的核因子E2相关因子2具有调控腹主动脉瘤血管平滑肌细胞表型转换的作用机制等[58]。Hosoyama等[59]现人源性多能应激耐受细胞增殖分化成血管平滑肌细胞和内皮细胞能力,且具有修复AD受累中层组织的潜能,修复后弹性纤维排列正常且未出现免疫排斥反应[60]。但干细胞治疗距离实际临床应用仍有很长的距离,未来仍需攻克干细胞分化效率低下、潜在致瘤性、脱靶效应高、无法大规模标准化生产等制约因素。

2.4 类器官助力药物筛选与治疗

       血管类器官结合微流控平台模拟体内血管与血液的交互作用,可同时研究血管壁生物力学反应和对药物反应[61] ;Zhu等[62]开发的主动脉平滑肌芯片模型可用于体外药物高通量筛选,为未来主动脉疾病的药物筛选提供了高效且高信度的平台。也有学者对类器官治疗血管疾病的可能性进行探索:植入到下肢缺血小鼠模型病变处的血管类器官可以自行增殖分化,复通原本闭塞的动[63-64]。目前,绝大多数的血管类器官仍以模拟微血管为主,缺少能模拟完整主动脉壁结构的血管类器官,限制了更全面、更拟真的主动脉疾病模型建立,主动脉类器官的建立将为我们认识主动脉疾病提供更优秀的模型平台。

3  我国主动脉外科亟待解决的问题

3.1 救治网络及同质化建设落后

       根据《中国心血管健康与疾病报告2023》的报道,我国近1/3的AD患者分型诊断缺失[65]。基于国家城镇职工医疗保险数据的AD流行病调查数据显示,近80%AD患者分型不明确[66]。我国主动脉疾病的流行病学数据缺乏颗粒度,使疾病时空分布及趋势认知失真,不仅影响卫生资源规划与调配,而且阻碍准确获悉主动脉疾病谱变化。
       另一方面,发达国家TAAD患者发病-就诊间隔时间约3.3小时,就诊-接受手术间隔时间约4.3小时[67-68];而我国TAAD院前平均转运距离为176.3 km,转运时间是国外的3倍,就诊-接受手术间隔时间为13小时[69]。此外,我国TAAD手术比例仅57.6%。非省会城市就诊TAAD手术比例更低(45.5%),非省会城市就诊患者手术死亡风险远高于省会城市就诊患者[70]。国家心血管病中心和国家心血管病临床研究中心应强化人才与技术下沉,提高手术技术规范普及,推进地区性同质化中心建设,建立多核心分布式AD转运网络。

3.2 长期影像随访依从性差

       加拿大学者研究发现AD患者术后一年影像随访完成率达100%,但第二年降至20%,8年完成率不足2%[71]。美国洛杉矶大学研究结果更消极,术后一月影像随访完成率仅为39.7%,第二年降至20%以下[72]。因此,各单位应形成区域性合作团队,加强出院教育,定期追踪性影像随访;建立区域性影像学随访中心,提高随访便利性;影像数据云端储存,信息实时共享。值得注意的是,目前推荐的随访周期尚无高质量循证证据支持,未来需确定合理的影像学随访周期,提高依从性。

3.3 缺少具有法规属性的诊疗指南

       截止去年,多个欧美学会/协会都制定了对应国情的主动脉疾病诊疗指南,并做阶段性更新。但我国临床活动仍主要参照专家共识,严重制约我国主动脉疾病整体诊疗水平及服务质量提高。与发达国家及地区相比,我国主动脉外科注册登记研究数量缺乏,难以形成与国情适配的临床诊疗指南。在国家高质量研究政策推动下,中华医学会和中国医师协会应积极牵头开展工作,以GRADE-EtD为理论框架,努力制定针对主动脉疾病的临床治疗指南。
        总之,国内外学者不仅在手术技术方面创新改进,还在交叉学科领域探究主动脉疾病尚未明晰之难题。虽然部分前沿学科虽仍处于实验探索初期,但其已经展现出颠覆性的应用潜力。如今,人工智能在外科领域的应用越发广泛,无论是手术辅助决策,还是药物蛋白结构预测与解构,都存在不可估量的预期应用价值。因此,未来主动脉外科的高速发展仍应坚持以解决实际临床问题为出发点,以人工智能为抓手,构建系统科学思维,组建多学科人才汇集的主动脉外科团队,使先进技术服务于科研活动,科研成果反哺临床诊疗,实现主动脉疾病患者的高质量预后。
1、ZHONG%E2%80%83Y%E2%80%83L%EF%BC%8CMA%E2%80%83W%E2%80%83G%EF%BC%8CZHU%E2%80%83J%E2%80%83M%EF%BC%8Cet%E2%80%83al%EF%BC%8E%0ASurgical%E2%80%83repair%E2%80%83of%E2%80%83cervical%E2%80%83aortic%E2%80%83arch%EF%BC%9AAn%E2%80%83alternative%E2%80%83%0Aclassification%E2%80%83%20scheme%E2%80%83%20based%E2%80%83%20on%E2%80%83%20experience%E2%80%83%20in%E2%80%83%2035%E2%80%83%0Apatients%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJ%E2%80%83Thorac%E2%80%83Cardiovasc%E2%80%83Surg%EF%BC%8C2020%EF%BC%8C159%0A%EF%BC%886%EF%BC%89%EF%BC%9A2202-2213%EF%BC%8Ee4%EF%BC%8EZHONG%E2%80%83Y%E2%80%83L%EF%BC%8CMA%E2%80%83W%E2%80%83G%EF%BC%8CZHU%E2%80%83J%E2%80%83M%EF%BC%8Cet%E2%80%83al%EF%BC%8E%0ASurgical%E2%80%83repair%E2%80%83of%E2%80%83cervical%E2%80%83aortic%E2%80%83arch%EF%BC%9AAn%E2%80%83alternative%E2%80%83%0Aclassification%E2%80%83%20scheme%E2%80%83%20based%E2%80%83%20on%E2%80%83%20experience%E2%80%83%20in%E2%80%83%2035%E2%80%83%0Apatients%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJ%E2%80%83Thorac%E2%80%83Cardiovasc%E2%80%83Surg%EF%BC%8C2020%EF%BC%8C159%0A%EF%BC%886%EF%BC%89%EF%BC%9A2202-2213%EF%BC%8Ee4%EF%BC%8E
2、MA%E2%80%83W%E2%80%83G%EF%BC%8CZHU%E2%80%83J%E2%80%83M%EF%BC%8CCHEN%E2%80%83Y%EF%BC%8Cet%E2%80%83al%EF%BC%8EAo%20rtic%E2%80%83%0Adissection%E2%80%83during%E2%80%83pregnancy%E2%80%83and%E2%80%83postpartum%E2%80%83in%E2%80%83patients%E2%80%83%0Awith%E2%80%83Marfan%E2%80%83syndrome%EF%BC%9AA%E2%80%8321-year%E2%80%83clinical%E2%80%83experience%E2%80%83%0Ain%E2%80%8330%E2%80%83patients%EF%BC%BBJ%EF%BC%BD%EF%BC%8EEur%E2%80%83J%E2%80%83Cardiothorac%E2%80%83Surg%EF%BC%8C%0A2020%EF%BC%8C58%EF%BC%882%EF%BC%89%EF%BC%9A294-301%EF%BC%8EMA%E2%80%83W%E2%80%83G%EF%BC%8CZHU%E2%80%83J%E2%80%83M%EF%BC%8CCHEN%E2%80%83Y%EF%BC%8Cet%E2%80%83al%EF%BC%8EAo%20rtic%E2%80%83%0Adissection%E2%80%83during%E2%80%83pregnancy%E2%80%83and%E2%80%83postpartum%E2%80%83in%E2%80%83patients%E2%80%83%0Awith%E2%80%83Marfan%E2%80%83syndrome%EF%BC%9AA%E2%80%8321-year%E2%80%83clinical%E2%80%83experience%E2%80%83%0Ain%E2%80%8330%E2%80%83patients%EF%BC%BBJ%EF%BC%BD%EF%BC%8EEur%E2%80%83J%E2%80%83Cardiothorac%E2%80%83Surg%EF%BC%8C%0A2020%EF%BC%8C58%EF%BC%882%EF%BC%89%EF%BC%9A294-301%EF%BC%8E
3、ZHU%E2%80%83J%E2%80%83M%EF%BC%8CMA%E2%80%83W%E2%80%83G%EF%BC%8CPETERSS%E2%80%83S%EF%BC%8Cet%E2%80%83al%EF%BC%8EAortic%E2%80%83%0Adissection%E2%80%83in%E2%80%83pregnancy%EF%BC%9AManagement%E2%80%83%20strategy%E2%80%83%20and%E2%80%83%0Aoutcomes%EF%BC%BBJ%EF%BC%BD%EF%BC%8EAnn%E2%80%83Thorac%E2%80%83Surg%EF%BC%8C2017%EF%BC%8C103%0A%EF%BC%884%EF%BC%89%EF%BC%9A1199-1206%EF%BC%8EZHU%E2%80%83J%E2%80%83M%EF%BC%8CMA%E2%80%83W%E2%80%83G%EF%BC%8CPETERSS%E2%80%83S%EF%BC%8Cet%E2%80%83al%EF%BC%8EAortic%E2%80%83%0Adissection%E2%80%83in%E2%80%83pregnancy%EF%BC%9AManagement%E2%80%83%20strategy%E2%80%83%20and%E2%80%83%0Aoutcomes%EF%BC%BBJ%EF%BC%BD%EF%BC%8EAnn%E2%80%83Thorac%E2%80%83Surg%EF%BC%8C2017%EF%BC%8C103%0A%EF%BC%884%EF%BC%89%EF%BC%9A1199-1206%EF%BC%8E
4、ISSELBACHER%E2%80%83E%E2%80%83M%EF%BC%8CPREVENTZA%E2%80%83O%EF%BC%8CHAMILTON%E2%80%83%0ABLACK%E2%80%83J%E2%80%83III%EF%BC%8Cet%E2%80%83al%EF%BC%8E2022%E2%80%83ACC%2FAHA%E2%80%83guideline%E2%80%83for%E2%80%83the%E2%80%83%0Adiagnosis%E2%80%83and%E2%80%83management%E2%80%83of%E2%80%83aortic%E2%80%83disease%EF%BC%9AA%E2%80%83%20report%E2%80%83%0Aof%E2%80%83the%E2%80%83American%E2%80%83%20heart%E2%80%83association%2FAmerican%E2%80%83%20college%E2%80%83%0Aof%E2%80%83%20cardiology%E2%80%83joint%E2%80%83%20committee%E2%80%83%20on%E2%80%83%20clinical%E2%80%83%20practice%E2%80%83%0Aguidelines%EF%BC%BBJ%EF%BC%BD%EF%BC%8ECirculation%EF%BC%8C2022%EF%BC%8C146%EF%BC%8824%EF%BC%89%EF%BC%9A%0Ae334-e482%EF%BC%8EISSELBACHER%E2%80%83E%E2%80%83M%EF%BC%8CPREVENTZA%E2%80%83O%EF%BC%8CHAMILTON%E2%80%83%0ABLACK%E2%80%83J%E2%80%83III%EF%BC%8Cet%E2%80%83al%EF%BC%8E2022%E2%80%83ACC%2FAHA%E2%80%83guideline%E2%80%83for%E2%80%83the%E2%80%83%0Adiagnosis%E2%80%83and%E2%80%83management%E2%80%83of%E2%80%83aortic%E2%80%83disease%EF%BC%9AA%E2%80%83%20report%E2%80%83%0Aof%E2%80%83the%E2%80%83American%E2%80%83%20heart%E2%80%83association%2FAmerican%E2%80%83%20college%E2%80%83%0Aof%E2%80%83%20cardiology%E2%80%83joint%E2%80%83%20committee%E2%80%83%20on%E2%80%83%20clinical%E2%80%83%20practice%E2%80%83%0Aguidelines%EF%BC%BBJ%EF%BC%BD%EF%BC%8ECirculation%EF%BC%8C2022%EF%BC%8C146%EF%BC%8824%EF%BC%89%EF%BC%9A%0Ae334-e482%EF%BC%8E
5、DONG%E2%80%83X%E2%80%83H%EF%BC%8CGE%E2%80%83Y%E2%80%83P%EF%BC%8CWANG%E2%80%83R%EF%BC%8Cet%E2%80%83al%EF%BC%8ESpinal%E2%80%83cord%E2%80%83%0Aprotection%E2%80%83of%E2%80%83aorto-iliac%E2%80%83bypass%E2%80%83in%E2%80%83open%E2%80%83repair%E2%80%83of%E2%80%83extent%E2%80%83%0AII%E2%80%83and%E2%80%83III%E2%80%83thoracoabdominal%E2%80%83aortic%E2%80%83aneurysm%EF%BC%BBJ%EF%BC%BD%EF%BC%8E%0AHeart%E2%80%83Lung%E2%80%83Circ%EF%BC%8C2022%EF%BC%8C31%EF%BC%882%EF%BC%89%EF%BC%9A255-262%EF%BC%8EDONG%E2%80%83X%E2%80%83H%EF%BC%8CGE%E2%80%83Y%E2%80%83P%EF%BC%8CWANG%E2%80%83R%EF%BC%8Cet%E2%80%83al%EF%BC%8ESpinal%E2%80%83cord%E2%80%83%0Aprotection%E2%80%83of%E2%80%83aorto-iliac%E2%80%83bypass%E2%80%83in%E2%80%83open%E2%80%83repair%E2%80%83of%E2%80%83extent%E2%80%83%0AII%E2%80%83and%E2%80%83III%E2%80%83thoracoabdominal%E2%80%83aortic%E2%80%83aneurysm%EF%BC%BBJ%EF%BC%BD%EF%BC%8E%0AHeart%E2%80%83Lung%E2%80%83Circ%EF%BC%8C2022%EF%BC%8C31%EF%BC%882%EF%BC%89%EF%BC%9A255-262%EF%BC%8E
6、DUAN%E2%80%83Y%E2%80%83Y%EF%BC%8CGE%E2%80%83Y%E2%80%83P%EF%BC%8CZHENG%E2%80%83J%EF%BC%8Cet%E2%80%83al%EF%BC%8EAorta-iliac%E2%80%83%0Abypass%E2%80%83in%E2%80%83thoracoabdominal%E2%80%83%20aortic%E2%80%83%20aneurysm%E2%80%83%20repair%E2%80%83%0Ain%E2%80%83young%E2%80%83Chinese%E2%80%83patients%EF%BC%BBJ%EF%BC%BD%EF%BC%8EHeart%E2%80%83Lung%E2%80%83Circ%EF%BC%8C%0A2016%EF%BC%8C25%EF%BC%884%EF%BC%89%EF%BC%9A398-404%EF%BC%8EDUAN%E2%80%83Y%E2%80%83Y%EF%BC%8CGE%E2%80%83Y%E2%80%83P%EF%BC%8CZHENG%E2%80%83J%EF%BC%8Cet%E2%80%83al%EF%BC%8EAorta-iliac%E2%80%83%0Abypass%E2%80%83in%E2%80%83thoracoabdominal%E2%80%83%20aortic%E2%80%83%20aneurysm%E2%80%83%20repair%E2%80%83%0Ain%E2%80%83young%E2%80%83Chinese%E2%80%83patients%EF%BC%BBJ%EF%BC%BD%EF%BC%8EHeart%E2%80%83Lung%E2%80%83Circ%EF%BC%8C%0A2016%EF%BC%8C25%EF%BC%884%EF%BC%89%EF%BC%9A398-404%EF%BC%8E
7、ROCHA%E2%80%83R%E2%80%83V%EF%BC%8CLINDSAY%E2%80%83T%E2%80%83F%EF%BC%8CAUSTIN%E2%80%83P%E2%80%83C%EF%BC%8C%0Aet%E2%80%83al%EF%BC%8EOutcomes%E2%80%83%20after%E2%80%83%20endovascular%E2%80%83%20versus%E2%80%83%20open%E2%80%83%0Athoracoabdominal%E2%80%83aortic%E2%80%83aneurysm%E2%80%83repair%EF%BC%9AA%E2%80%83%0Apopulation-based%E2%80%83study%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJ%E2%80%83Thorac%E2%80%83Cardiovasc%E2%80%83%0ASurg%EF%BC%8C2021%EF%BC%8C161%EF%BC%882%EF%BC%89%EF%BC%9A516-527%EF%BC%8Ee6%EF%BC%8EROCHA%E2%80%83R%E2%80%83V%EF%BC%8CLINDSAY%E2%80%83T%E2%80%83F%EF%BC%8CAUSTIN%E2%80%83P%E2%80%83C%EF%BC%8C%0Aet%E2%80%83al%EF%BC%8EOutcomes%E2%80%83%20after%E2%80%83%20endovascular%E2%80%83%20versus%E2%80%83%20open%E2%80%83%0Athoracoabdominal%E2%80%83aortic%E2%80%83aneurysm%E2%80%83repair%EF%BC%9AA%E2%80%83%0Apopulation-based%E2%80%83study%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJ%E2%80%83Thorac%E2%80%83Cardiovasc%E2%80%83%0ASurg%EF%BC%8C2021%EF%BC%8C161%EF%BC%882%EF%BC%89%EF%BC%9A516-527%EF%BC%8Ee6%EF%BC%8E
8、WIPPER%E2%80%83S%EF%BC%8CK%C3%96LBEL%E2%80%83T%EF%BC%8CSANDHU%E2%80%83H%E2%80%83K%EF%BC%8Cet%E2%80%83al%EF%BC%8E%0AImpact%E2%80%83%20of%E2%80%83%20hybrid%E2%80%83thoracoabdominal%E2%80%83%20aortic%E2%80%83%20repair%E2%80%83%20on%E2%80%83%0Avisceral%E2%80%83and%E2%80%83spinal%E2%80%83cord%E2%80%83perfusion%EF%BC%9AThe%E2%80%83%20new%E2%80%83%20and%E2%80%83improved%E2%80%83SPIDER-graft%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJ%E2%80%83Thorac%E2%80%83Cardiovasc%E2%80%83%0ASurg%EF%BC%8C2019%EF%BC%8C158%EF%BC%883%EF%BC%89%EF%BC%9A692-701%EF%BC%8EWIPPER%E2%80%83S%EF%BC%8CK%C3%96LBEL%E2%80%83T%EF%BC%8CSANDHU%E2%80%83H%E2%80%83K%EF%BC%8Cet%E2%80%83al%EF%BC%8E%0AImpact%E2%80%83%20of%E2%80%83%20hybrid%E2%80%83thoracoabdominal%E2%80%83%20aortic%E2%80%83%20repair%E2%80%83%20on%E2%80%83%0Avisceral%E2%80%83and%E2%80%83spinal%E2%80%83cord%E2%80%83perfusion%EF%BC%9AThe%E2%80%83%20new%E2%80%83%20and%E2%80%83improved%E2%80%83SPIDER-graft%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJ%E2%80%83Thorac%E2%80%83Cardiovasc%E2%80%83%0ASurg%EF%BC%8C2019%EF%BC%8C158%EF%BC%883%EF%BC%89%EF%BC%9A692-701%EF%BC%8E
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12、MA%E2%80%83W%E2%80%83G%EF%BC%8CCHEN%E2%80%83Y%EF%BC%8CZHANG%E2%80%83W%EF%BC%8Cet%E2%80%83al%EF%BC%8EExtended%E2%80%83%0Arepair%E2%80%83for%E2%80%83acute%E2%80%83type%E2%80%83A%E2%80%83aortic%E2%80%83dissection%EF%BC%9ALong-term%E2%80%83%0Aoutcomes%E2%80%83of%E2%80%83the%E2%80%83frozen%E2%80%83elephant%E2%80%83trunk%E2%80%83technique%E2%80%83beyond%E2%80%83%0A10%E2%80%83years%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJ%E2%80%83Cardiovasc%E2%80%83Surg%EF%BC%8C2020%EF%BC%8C61%EF%BC%883%EF%BC%89%EF%BC%9A%0A292-300%EF%BC%8EMA%E2%80%83W%E2%80%83G%EF%BC%8CCHEN%E2%80%83Y%EF%BC%8CZHANG%E2%80%83W%EF%BC%8Cet%E2%80%83al%EF%BC%8EExtended%E2%80%83%0Arepair%E2%80%83for%E2%80%83acute%E2%80%83type%E2%80%83A%E2%80%83aortic%E2%80%83dissection%EF%BC%9ALong-term%E2%80%83%0Aoutcomes%E2%80%83of%E2%80%83the%E2%80%83frozen%E2%80%83elephant%E2%80%83trunk%E2%80%83technique%E2%80%83beyond%E2%80%83%0A10%E2%80%83years%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJ%E2%80%83Cardiovasc%E2%80%83Surg%EF%BC%8C2020%EF%BC%8C61%EF%BC%883%EF%BC%89%EF%BC%9A%0A292-300%EF%BC%8E
13、中国医师协会心血管外科分会大血管外科专业委员会.主动脉夹层诊断与治疗规范中国专家共识[J].中华胸心血管外科杂志,2017,33(11):641-654.中国医师协会心血管外科分会大血管外科专业委员会.主动脉夹层诊断与治疗规范中国专家共识[J].中华胸心血管外科杂志,2017,33(11):641-654.
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15、%E2%80%83%20HE%E2%80%83J%EF%BC%8CPENG%E2%80%83J%EF%BC%8CLI%E2%80%83W%EF%BC%8Cet%E2%80%83al%EF%BC%8E%E2%80%9CAorta-clamp%E2%80%9D%0Atechnique%E2%80%83for%E2%80%83%20surgical%E2%80%83%20repair%E2%80%83%20of%E2%80%83%20acute%E2%80%83type%E2%80%83A%E2%80%83%20aortic%E2%80%83%0Adissection-5%E2%80%83Min%E2%80%83circulatory%E2%80%83arrest%E2%80%83at%E2%80%8330%E2%80%83%E2%84%83%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJ%E2%80%83%0AThorac%E2%80%83Dis%EF%BC%8C2019%EF%BC%8C11%EF%BC%8811%EF%BC%89%EF%BC%9A4717-4724%EF%BC%8E%E2%80%83%20HE%E2%80%83J%EF%BC%8CPENG%E2%80%83J%EF%BC%8CLI%E2%80%83W%EF%BC%8Cet%E2%80%83al%EF%BC%8E%E2%80%9CAorta-clamp%E2%80%9D%0Atechnique%E2%80%83for%E2%80%83%20surgical%E2%80%83%20repair%E2%80%83%20of%E2%80%83%20acute%E2%80%83type%E2%80%83A%E2%80%83%20aortic%E2%80%83%0Adissection-5%E2%80%83Min%E2%80%83circulatory%E2%80%83arrest%E2%80%83at%E2%80%8330%E2%80%83%E2%84%83%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJ%E2%80%83%0AThorac%E2%80%83Dis%EF%BC%8C2019%EF%BC%8C11%EF%BC%8811%EF%BC%89%EF%BC%9A4717-4724%EF%BC%8E
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30、VALL%C3%89E%E2%80%83A%EF%BC%8CGUIMBRETI%C3%88RE%E2%80%83G%EF%BC%8CGUIHAIRE%E2%80%83J%EF%BC%8Cet%E2%80%83%0Aal%EF%BC%8EAnatomical%E2%80%83feasibility%E2%80%83of%E2%80%83endobentall%E2%80%83strategies%E2%80%83for%E2%80%83%0Amanagement%E2%80%83of%E2%80%83acute%E2%80%83type%E2%80%83a%E2%80%83aortic%E2%80%83dissection%EF%BC%BBJ%EF%BC%BD%EF%BC%8E%0AAnn%E2%80%83Surg%EF%BC%8C2024%EF%BC%9A00000658-990000000-01089%EF%BC%8EVALL%C3%89E%E2%80%83A%EF%BC%8CGUIMBRETI%C3%88RE%E2%80%83G%EF%BC%8CGUIHAIRE%E2%80%83J%EF%BC%8Cet%E2%80%83%0Aal%EF%BC%8EAnatomical%E2%80%83feasibility%E2%80%83of%E2%80%83endobentall%E2%80%83strategies%E2%80%83for%E2%80%83%0Amanagement%E2%80%83of%E2%80%83acute%E2%80%83type%E2%80%83a%E2%80%83aortic%E2%80%83dissection%EF%BC%BBJ%EF%BC%BD%EF%BC%8E%0AAnn%E2%80%83Surg%EF%BC%8C2024%EF%BC%9A00000658-990000000-01089%EF%BC%8E
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32、SPATH%E2%80%83P%EF%BC%8CCAMPANA%E2%80%83F%EF%BC%8CTSILIMPARIS%E2%80%83N%EF%BC%8Cet%E2%80%83al%EF%BC%8E%0AOutcomes%E2%80%83of%E2%80%83fenestrated%E2%80%83and%E2%80%83%20branched%E2%80%83endografts%E2%80%83for%E2%80%83%0Apartial%E2%80%83and%E2%80%83total%E2%80%83endovascular%E2%80%83%20repair%E2%80%83of%E2%80%83the%E2%80%83aortic%E2%80%83arch%E2%80%83%0A-%E2%80%83a%E2%80%83systematic%E2%80%83review%E2%80%83and%E2%80%83meta-analysis%EF%BC%BBJ%EF%BC%BD%EF%BC%8EEur%E2%80%83J%E2%80%83%0AVasc%E2%80%83Endovasc%E2%80%83Surg%EF%BC%8C2024%EF%BC%8C67%EF%BC%881%EF%BC%89%EF%BC%9A106-116%EF%BC%8ESPATH%E2%80%83P%EF%BC%8CCAMPANA%E2%80%83F%EF%BC%8CTSILIMPARIS%E2%80%83N%EF%BC%8Cet%E2%80%83al%EF%BC%8E%0AOutcomes%E2%80%83of%E2%80%83fenestrated%E2%80%83and%E2%80%83%20branched%E2%80%83endografts%E2%80%83for%E2%80%83%0Apartial%E2%80%83and%E2%80%83total%E2%80%83endovascular%E2%80%83%20repair%E2%80%83of%E2%80%83the%E2%80%83aortic%E2%80%83arch%E2%80%83%0A-%E2%80%83a%E2%80%83systematic%E2%80%83review%E2%80%83and%E2%80%83meta-analysis%EF%BC%BBJ%EF%BC%BD%EF%BC%8EEur%E2%80%83J%E2%80%83%0AVasc%E2%80%83Endovasc%E2%80%83Surg%EF%BC%8C2024%EF%BC%8C67%EF%BC%881%EF%BC%89%EF%BC%9A106-116%EF%BC%8E
33、BASHA%E2%80%83A%E2%80%83M%EF%BC%8CMOORE%E2%80%83R%E2%80%83D%EF%BC%8CROMMENS%E2%80%83K%E2%80%83L%EF%BC%8Cet%E2%80%83%0Aal%EF%BC%8EA%E2%80%83%20systematic%E2%80%83%20review%E2%80%83of%E2%80%83total%E2%80%83endovascular%E2%80%83aortic%E2%80%83%0Aarch%E2%80%83repair%EF%BC%9AA%E2%80%83promising%E2%80%83technology%EF%BC%BBJ%EF%BC%BD%EF%BC%8ECan%E2%80%83%20J%E2%80%83%0ACardiol%EF%BC%8C2023%EF%BC%8C39%EF%BC%881%EF%BC%89%EF%BC%9A49-56%EF%BC%8EBASHA%E2%80%83A%E2%80%83M%EF%BC%8CMOORE%E2%80%83R%E2%80%83D%EF%BC%8CROMMENS%E2%80%83K%E2%80%83L%EF%BC%8Cet%E2%80%83%0Aal%EF%BC%8EA%E2%80%83%20systematic%E2%80%83%20review%E2%80%83of%E2%80%83total%E2%80%83endovascular%E2%80%83aortic%E2%80%83%0Aarch%E2%80%83repair%EF%BC%9AA%E2%80%83promising%E2%80%83technology%EF%BC%BBJ%EF%BC%BD%EF%BC%8ECan%E2%80%83%20J%E2%80%83%0ACardiol%EF%BC%8C2023%EF%BC%8C39%EF%BC%881%EF%BC%89%EF%BC%9A49-56%EF%BC%8E
34、%E2%80%83PLANER%E2%80%83D%20%EF%BC%8C%20ELBAZ-GREENER%E2%80%83G%20%EF%BC%8C%0AMANGIALARDI%E2%80%83N%EF%BC%8Cet%E2%80%83al%EF%BC%8ENEXUS%E2%80%83arch%EF%BC%9AA%E2%80%83%0Amulticenter%E2%80%83%20study%E2%80%83%20evaluating%E2%80%83the%E2%80%83initial%E2%80%83%20experience%E2%80%83%0Awith%E2%80%83a%E2%80%83novel%E2%80%83aortic%E2%80%83arch%E2%80%83stent%E2%80%83graft%E2%80%83system%EF%BC%BBJ%EF%BC%BD%EF%BC%8EAnn%E2%80%83%0ASurg%EF%BC%8C2023%EF%BC%8C277%EF%BC%882%EF%BC%89%EF%BC%9Ae460-e466%EF%BC%8E%E2%80%83PLANER%E2%80%83D%20%EF%BC%8C%20ELBAZ-GREENER%E2%80%83G%20%EF%BC%8C%0AMANGIALARDI%E2%80%83N%EF%BC%8Cet%E2%80%83al%EF%BC%8ENEXUS%E2%80%83arch%EF%BC%9AA%E2%80%83%0Amulticenter%E2%80%83%20study%E2%80%83%20evaluating%E2%80%83the%E2%80%83initial%E2%80%83%20experience%E2%80%83%0Awith%E2%80%83a%E2%80%83novel%E2%80%83aortic%E2%80%83arch%E2%80%83stent%E2%80%83graft%E2%80%83system%EF%BC%BBJ%EF%BC%BD%EF%BC%8EAnn%E2%80%83%0ASurg%EF%BC%8C2023%EF%BC%8C277%EF%BC%882%EF%BC%89%EF%BC%9Ae460-e466%EF%BC%8E
35、DONG%E2%80%83H%EF%BC%8CFU%E2%80%83W%EF%BC%8CZHANG%E2%80%83W%E2%80%83W%EF%BC%8EFirst-in-man%E2%80%83%0AZIPPER%E2%84%A2%E2%80%83%20endograft%E2%80%83%20system%E2%80%83%20for%E2%80%83%20the%E2%80%83%20treatment%E2%80%83%20of%E2%80%83%0Asymptomatic%E2%80%83aortic%E2%80%83arch%E2%80%83intramural%E2%80%83haematoma%EF%BC%BBJ%EF%BC%BD%EF%BC%8E%0AEur%E2%80%83Heart%E2%80%83J%E2%80%83Case%E2%80%83Rep%EF%BC%8C2023%EF%BC%8C7%EF%BC%8811%EF%BC%89%EF%BC%9Aytad574%EF%BC%8EDONG%E2%80%83H%EF%BC%8CFU%E2%80%83W%EF%BC%8CZHANG%E2%80%83W%E2%80%83W%EF%BC%8EFirst-in-man%E2%80%83%0AZIPPER%E2%84%A2%E2%80%83%20endograft%E2%80%83%20system%E2%80%83%20for%E2%80%83%20the%E2%80%83%20treatment%E2%80%83%20of%E2%80%83%0Asymptomatic%E2%80%83aortic%E2%80%83arch%E2%80%83intramural%E2%80%83haematoma%EF%BC%BBJ%EF%BC%BD%EF%BC%8E%0AEur%E2%80%83Heart%E2%80%83J%E2%80%83Case%E2%80%83Rep%EF%BC%8C2023%EF%BC%8C7%EF%BC%8811%EF%BC%89%EF%BC%9Aytad574%EF%BC%8E
36、ZHANG%E2%80%83L%EF%BC%8CLU%E2%80%83Q%EF%BC%8CZHU%E2%80%83H%EF%BC%8Cet%E2%80%83al%EF%BC%8EBranch%E2%80%83stent%02grafting%E2%80%83for%E2%80%83endovascular%E2%80%83%20repair%E2%80%83of%E2%80%83chronic%E2%80%83aortic%E2%80%83arch%E2%80%83%0Adissection%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJ%E2%80%83Thorac%E2%80%83Cardiovasc%E2%80%83Surg%EF%BC%8C2021%EF%BC%8C%0A162%EF%BC%881%EF%BC%89%EF%BC%9A12-22%EF%BC%8Ee1%EF%BC%8EZHANG%E2%80%83L%EF%BC%8CLU%E2%80%83Q%EF%BC%8CZHU%E2%80%83H%EF%BC%8Cet%E2%80%83al%EF%BC%8EBranch%E2%80%83stent%02grafting%E2%80%83for%E2%80%83endovascular%E2%80%83%20repair%E2%80%83of%E2%80%83chronic%E2%80%83aortic%E2%80%83arch%E2%80%83%0Adissection%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJ%E2%80%83Thorac%E2%80%83Cardiovasc%E2%80%83Surg%EF%BC%8C2021%EF%BC%8C%0A162%EF%BC%881%EF%BC%89%EF%BC%9A12-22%EF%BC%8Ee1%EF%BC%8E
37、%E2%80%83%20SONG%E2%80%83S%E2%80%83W%EF%BC%8CLEE%E2%80%83H%EF%BC%8CKIM%E2%80%83M%E2%80%83S%EF%BC%8Cet%E2%80%83al%EF%BC%8ENext%02generation%E2%80%83frozen%E2%80%83elephant%E2%80%83trunk%E2%80%83technique%E2%80%83in%E2%80%83the%E2%80%83era%E2%80%83%0Aof%E2%80%83precision%E2%80%83medicine%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJ%E2%80%83Chest%E2%80%83Surg%EF%BC%8C2024%EF%BC%8C57%0A%EF%BC%885%EF%BC%89%EF%BC%9A419-429%EF%BC%8E%E2%80%83%20SONG%E2%80%83S%E2%80%83W%EF%BC%8CLEE%E2%80%83H%EF%BC%8CKIM%E2%80%83M%E2%80%83S%EF%BC%8Cet%E2%80%83al%EF%BC%8ENext%02generation%E2%80%83frozen%E2%80%83elephant%E2%80%83trunk%E2%80%83technique%E2%80%83in%E2%80%83the%E2%80%83era%E2%80%83%0Aof%E2%80%83precision%E2%80%83medicine%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJ%E2%80%83Chest%E2%80%83Surg%EF%BC%8C2024%EF%BC%8C57%0A%EF%BC%885%EF%BC%89%EF%BC%9A419-429%EF%BC%8E
38、NAKAHARA%E2%80%83T%EF%BC%8CMIYAZAWA%E2%80%83R%EF%BC%8CIWABUCHI%E2%80%83Y%EF%BC%8Cet%E2%80%83%0Aal%EF%BC%8EAortic%E2%80%83uptake%E2%80%83of%EF%BC%8818%EF%BC%89F-NaF%E2%80%83and%EF%BC%8818%EF%BC%89F-FDG%E2%80%83%0Aand%E2%80%83calcification%E2%80%83predict%E2%80%83the%E2%80%83development%E2%80%83of%E2%80%83abdominal%E2%80%83aortic%E2%80%83aneurysms%E2%80%83and%E2%80%83is%E2%80%83attenuated%E2%80%83by%E2%80%83drug%E2%80%83therapy%0A%EF%BC%BBJ%EF%BC%BD%EF%BC%8EArterioscler%E2%80%83Thromb%E2%80%83Vasc%E2%80%83Biol%EF%BC%8C2024%EF%BC%8C44%0A%EF%BC%889%EF%BC%89%EF%BC%9A1975-1985%EF%BC%8ENAKAHARA%E2%80%83T%EF%BC%8CMIYAZAWA%E2%80%83R%EF%BC%8CIWABUCHI%E2%80%83Y%EF%BC%8Cet%E2%80%83%0Aal%EF%BC%8EAortic%E2%80%83uptake%E2%80%83of%EF%BC%8818%EF%BC%89F-NaF%E2%80%83and%EF%BC%8818%EF%BC%89F-FDG%E2%80%83%0Aand%E2%80%83calcification%E2%80%83predict%E2%80%83the%E2%80%83development%E2%80%83of%E2%80%83abdominal%E2%80%83aortic%E2%80%83aneurysms%E2%80%83and%E2%80%83is%E2%80%83attenuated%E2%80%83by%E2%80%83drug%E2%80%83therapy%0A%EF%BC%BBJ%EF%BC%BD%EF%BC%8EArterioscler%E2%80%83Thromb%E2%80%83Vasc%E2%80%83Biol%EF%BC%8C2024%EF%BC%8C44%0A%EF%BC%889%EF%BC%89%EF%BC%9A1975-1985%EF%BC%8E
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58、%E2%80%83%20XIAO%E2%80%83X%EF%BC%8CLI%E2%80%83C%EF%BC%8CHUANG%E2%80%83X%EF%BC%8Cet%E2%80%83al%EF%BC%8ESingle-cell%E2%80%83RNA%E2%80%83%0Asequencing%E2%80%83reveals%E2%80%83that%E2%80%83NRF2%E2%80%83regulates%E2%80%83vascular%E2%80%83smooth%E2%80%83%0Amuscle%E2%80%83cell%E2%80%83phenotypic%E2%80%83switching%E2%80%83in%E2%80%83abdominal%E2%80%83aortic%E2%80%83%0Aaneurysm%EF%BC%BBJ%EF%BC%BD%EF%BC%8EFASEB%E2%80%83J%EF%BC%8C2024%EF%BC%8C38%EF%BC%8813%EF%BC%89%EF%BC%9A%0Ae23707%EF%BC%8E%E2%80%83%20XIAO%E2%80%83X%EF%BC%8CLI%E2%80%83C%EF%BC%8CHUANG%E2%80%83X%EF%BC%8Cet%E2%80%83al%EF%BC%8ESingle-cell%E2%80%83RNA%E2%80%83%0Asequencing%E2%80%83reveals%E2%80%83that%E2%80%83NRF2%E2%80%83regulates%E2%80%83vascular%E2%80%83smooth%E2%80%83%0Amuscle%E2%80%83cell%E2%80%83phenotypic%E2%80%83switching%E2%80%83in%E2%80%83abdominal%E2%80%83aortic%E2%80%83%0Aaneurysm%EF%BC%BBJ%EF%BC%BD%EF%BC%8EFASEB%E2%80%83J%EF%BC%8C2024%EF%BC%8C38%EF%BC%8813%EF%BC%89%EF%BC%9A%0Ae23707%EF%BC%8E
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64、DING%E2%80%83Y%EF%BC%8CZHAO%E2%80%83A%E2%80%83S%EF%BC%8CLIU%E2%80%83T%EF%BC%8Cet%E2%80%83al%EF%BC%8EAn%E2%80%83injectable%E2%80%83%0Ananocomposite%E2%80%83%20hydrogel%E2%80%83for%E2%80%83%20potential%E2%80%83%20application%E2%80%83%20of%E2%80%83%0Avascularization%E2%80%83and%E2%80%83tissue%E2%80%83repair%EF%BC%BBJ%EF%BC%BD%EF%BC%8EAnn%E2%80%83Biomed%E2%80%83%0AEng%EF%BC%8C2020%EF%BC%8C48%EF%BC%885%EF%BC%89%EF%BC%9A1511-1523%EF%BC%8EDING%E2%80%83Y%EF%BC%8CZHAO%E2%80%83A%E2%80%83S%EF%BC%8CLIU%E2%80%83T%EF%BC%8Cet%E2%80%83al%EF%BC%8EAn%E2%80%83injectable%E2%80%83%0Ananocomposite%E2%80%83%20hydrogel%E2%80%83for%E2%80%83%20potential%E2%80%83%20application%E2%80%83%20of%E2%80%83%0Avascularization%E2%80%83and%E2%80%83tissue%E2%80%83repair%EF%BC%BBJ%EF%BC%BD%EF%BC%8EAnn%E2%80%83Biomed%E2%80%83%0AEng%EF%BC%8C2020%EF%BC%8C48%EF%BC%885%EF%BC%89%EF%BC%9A1511-1523%EF%BC%8E
65、国家心血管病中心.中国心血管健康与疾病报告-2023,2023[M].北京:中国协和医科大学出版社,2024.国家心血管病中心.中国心血管健康与疾病报告-2023,2023[M].北京:中国协和医科大学出版社,2024.
66、TANG%E2%80%83X%EF%BC%8CLU%E2%80%83K%EF%BC%8CLIU%E2%80%83X%EF%BC%8Cet%E2%80%83al%EF%BC%8EIncidence%E2%80%83%20and%E2%80%83%0Asurvival%E2%80%83of%E2%80%83aortic%E2%80%83dissection%E2%80%83in%E2%80%83urban%E2%80%83China%EF%BC%9AResults%E2%80%83%0Afrom%E2%80%83the%E2%80%83national%E2%80%83insurance%E2%80%83claims%E2%80%83for%E2%80%83epidemiological%E2%80%83%0Aresearch%EF%BC%88NICER%EF%BC%89study%EF%BC%BBJ%EF%BC%BD%EF%BC%8ELancet%E2%80%83Reg%E2%80%83Health%E2%80%83%0AWest%E2%80%83Pac%EF%BC%8C2021%EF%BC%8817%EF%BC%89%EF%BC%9A100280%EF%BC%8ETANG%E2%80%83X%EF%BC%8CLU%E2%80%83K%EF%BC%8CLIU%E2%80%83X%EF%BC%8Cet%E2%80%83al%EF%BC%8EIncidence%E2%80%83%20and%E2%80%83%0Asurvival%E2%80%83of%E2%80%83aortic%E2%80%83dissection%E2%80%83in%E2%80%83urban%E2%80%83China%EF%BC%9AResults%E2%80%83%0Afrom%E2%80%83the%E2%80%83national%E2%80%83insurance%E2%80%83claims%E2%80%83for%E2%80%83epidemiological%E2%80%83%0Aresearch%EF%BC%88NICER%EF%BC%89study%EF%BC%BBJ%EF%BC%BD%EF%BC%8ELancet%E2%80%83Reg%E2%80%83Health%E2%80%83%0AWest%E2%80%83Pac%EF%BC%8C2021%EF%BC%8817%EF%BC%89%EF%BC%9A100280%EF%BC%8E
67、%E2%80%83%20INOUE%E2%80%83Y%EF%BC%8CMATSUDA%E2%80%83H%EF%BC%8CUCHIDA%E2%80%83K%EF%BC%8Cet%E2%80%83al%EF%BC%8E%0AAnalysis%E2%80%83%20of%E2%80%83%20acute%E2%80%83type%E2%80%83%20a%E2%80%83%20aortic%E2%80%83%20dissection%E2%80%83in%E2%80%83%20Japan%E2%80%83%0Aregistry%E2%80%83of%E2%80%83aortic%E2%80%83dissection%EF%BC%88JRAD%EF%BC%89%EF%BC%BBJ%EF%BC%BD%EF%BC%8EAnn%E2%80%83%0AThorac%E2%80%83Surg%EF%BC%8C2020%EF%BC%8C110%EF%BC%883%EF%BC%89%EF%BC%9A790-798%EF%BC%8E%E2%80%83%20INOUE%E2%80%83Y%EF%BC%8CMATSUDA%E2%80%83H%EF%BC%8CUCHIDA%E2%80%83K%EF%BC%8Cet%E2%80%83al%EF%BC%8E%0AAnalysis%E2%80%83%20of%E2%80%83%20acute%E2%80%83type%E2%80%83%20a%E2%80%83%20aortic%E2%80%83%20dissection%E2%80%83in%E2%80%83%20Japan%E2%80%83%0Aregistry%E2%80%83of%E2%80%83aortic%E2%80%83dissection%EF%BC%88JRAD%EF%BC%89%EF%BC%BBJ%EF%BC%BD%EF%BC%8EAnn%E2%80%83%0AThorac%E2%80%83Surg%EF%BC%8C2020%EF%BC%8C110%EF%BC%883%EF%BC%89%EF%BC%9A790-798%EF%BC%8E
68、HARRIS%E2%80%83K%E2%80%83M%EF%BC%8CSTRAUSS%E2%80%83C%E2%80%83E%EF%BC%8CEAGLE%E2%80%83K%E2%80%83A%EF%BC%8Cet%E2%80%83al%EF%BC%8E%0ACorrelates%E2%80%83%20of%E2%80%83%20delayed%E2%80%83%20recognition%E2%80%83%20and%E2%80%83treatment%E2%80%83%20of%E2%80%83%0Aacute%E2%80%83type%E2%80%83A%E2%80%83aortic%E2%80%83dissection%EF%BC%9AThe%E2%80%83%20International%E2%80%83%0ARegistry%E2%80%83of%E2%80%83Acute%E2%80%83Aortic%E2%80%83Dissection%EF%BC%88IRAD%EF%BC%89%EF%BC%BBJ%EF%BC%BD%EF%BC%8E%0ACirculation%EF%BC%8C2011%EF%BC%8C124%EF%BC%8818%EF%BC%89%EF%BC%9A1911-1918%EF%BC%8EHARRIS%E2%80%83K%E2%80%83M%EF%BC%8CSTRAUSS%E2%80%83C%E2%80%83E%EF%BC%8CEAGLE%E2%80%83K%E2%80%83A%EF%BC%8Cet%E2%80%83al%EF%BC%8E%0ACorrelates%E2%80%83%20of%E2%80%83%20delayed%E2%80%83%20recognition%E2%80%83%20and%E2%80%83treatment%E2%80%83%20of%E2%80%83%0Aacute%E2%80%83type%E2%80%83A%E2%80%83aortic%E2%80%83dissection%EF%BC%9AThe%E2%80%83%20International%E2%80%83%0ARegistry%E2%80%83of%E2%80%83Acute%E2%80%83Aortic%E2%80%83Dissection%EF%BC%88IRAD%EF%BC%89%EF%BC%BBJ%EF%BC%BD%EF%BC%8E%0ACirculation%EF%BC%8C2011%EF%BC%8C124%EF%BC%8818%EF%BC%89%EF%BC%9A1911-1918%EF%BC%8E
69、ZHAO%E2%80%83R%EF%BC%8CQIU%E2%80%83J%EF%BC%8CDAI%E2%80%83L%EF%BC%8Cet%E2%80%83al%EF%BC%8ECurrent%E2%80%83%20surgical%E2%80%83%0Amanagement%E2%80%83of%E2%80%83acute%E2%80%83type%E2%80%83a%E2%80%83aortic%E2%80%83dissection%E2%80%83in%E2%80%83China%EF%BC%9A%0AA%E2%80%83multicenter%E2%80%83registry%E2%80%83study%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJACC%E2%80%83Asia%EF%BC%8C%0A2022%EF%BC%8C2%EF%BC%887%EF%BC%89%EF%BC%9A869-878%EF%BC%8EZHAO%E2%80%83R%EF%BC%8CQIU%E2%80%83J%EF%BC%8CDAI%E2%80%83L%EF%BC%8Cet%E2%80%83al%EF%BC%8ECurrent%E2%80%83%20surgical%E2%80%83%0Amanagement%E2%80%83of%E2%80%83acute%E2%80%83type%E2%80%83a%E2%80%83aortic%E2%80%83dissection%E2%80%83in%E2%80%83China%EF%BC%9A%0AA%E2%80%83multicenter%E2%80%83registry%E2%80%83study%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJACC%E2%80%83Asia%EF%BC%8C%0A2022%EF%BC%8C2%EF%BC%887%EF%BC%89%EF%BC%9A869-878%EF%BC%8E
70、LIU%E2%80%83L%E2%80%83W%EF%BC%8CCUI%E2%80%83Y%E2%80%83K%EF%BC%8CZHANG%E2%80%83L%EF%BC%8Cet%E2%80%83al%EF%BC%8EEffectiveness%E2%80%83%0Aof%E2%80%83%20chest%E2%80%83%20pain%E2%80%83%20center%E2%80%83%20accreditation%E2%80%83%20on%E2%80%83the%E2%80%83%20hospital%E2%80%83%0Aoutcome%E2%80%83of%E2%80%83acute%E2%80%83aortic%E2%80%83dissection%EF%BC%9AA%E2%80%83nationwide%E2%80%83study%E2%80%83%0Ain%E2%80%83China%EF%BC%BBJ%EF%BC%BD%EF%BC%8EMil%E2%80%83Med%E2%80%83Res%EF%BC%8C2024%EF%BC%8C11%EF%BC%881%EF%BC%89%EF%BC%9A62%EF%BC%8ELIU%E2%80%83L%E2%80%83W%EF%BC%8CCUI%E2%80%83Y%E2%80%83K%EF%BC%8CZHANG%E2%80%83L%EF%BC%8Cet%E2%80%83al%EF%BC%8EEffectiveness%E2%80%83%0Aof%E2%80%83%20chest%E2%80%83%20pain%E2%80%83%20center%E2%80%83%20accreditation%E2%80%83%20on%E2%80%83the%E2%80%83%20hospital%E2%80%83%0Aoutcome%E2%80%83of%E2%80%83acute%E2%80%83aortic%E2%80%83dissection%EF%BC%9AA%E2%80%83nationwide%E2%80%83study%E2%80%83%0Ain%E2%80%83China%EF%BC%BBJ%EF%BC%BD%EF%BC%8EMil%E2%80%83Med%E2%80%83Res%EF%BC%8C2024%EF%BC%8C11%EF%BC%881%EF%BC%89%EF%BC%9A62%EF%BC%8E
71、AN%E2%80%83K%E2%80%83R%EF%BC%8Cde%E2%80%83MESTRAL%E2%80%83C%EF%BC%8CTAM%E2%80%83D%E2%80%83Y%EF%BC%8Cet%E2%80%83al%EF%BC%8E%0ASurveillance%E2%80%83imaging%E2%80%83following%E2%80%83%20acute%E2%80%83type%E2%80%83%20a%E2%80%83%20aortic%E2%80%83%0Adissection%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJ%E2%80%83Am%E2%80%83Coll%E2%80%83Cardiol%EF%BC%8C2021%EF%BC%8C78%0A%EF%BC%8819%EF%BC%89%EF%BC%9A1863-1871%EF%BC%8EAN%E2%80%83K%E2%80%83R%EF%BC%8Cde%E2%80%83MESTRAL%E2%80%83C%EF%BC%8CTAM%E2%80%83D%E2%80%83Y%EF%BC%8Cet%E2%80%83al%EF%BC%8E%0ASurveillance%E2%80%83imaging%E2%80%83following%E2%80%83%20acute%E2%80%83type%E2%80%83%20a%E2%80%83%20aortic%E2%80%83%0Adissection%EF%BC%BBJ%EF%BC%BD%EF%BC%8EJ%E2%80%83Am%E2%80%83Coll%E2%80%83Cardiol%EF%BC%8C2021%EF%BC%8C78%0A%EF%BC%8819%EF%BC%89%EF%BC%9A1863-1871%EF%BC%8E
72、%E2%80%83%20FLANAGAN%E2%80%83C%E2%80%83P%EF%BC%8CKIM%E2%80%83A%E2%80%83S%EF%BC%8CRAMIREZ%E2%80%83J%E2%80%83L%EF%BC%8Cet%E2%80%83al%EF%BC%8E%0ALow%E2%80%83%20rates%E2%80%83of%E2%80%83aortic%E2%80%83%20surveillance%E2%80%83imaging%E2%80%83and%E2%80%83clinical%E2%80%83%0Afollow-up%E2%80%83in%E2%80%83patients%E2%80%83with%E2%80%83acute%E2%80%83aortic%E2%80%83dissection%EF%BC%BBJ%EF%BC%BD%EF%BC%8E%0AJ%E2%80%83Vasc%E2%80%83Surg%EF%BC%8C2025%EF%BC%8C81%EF%BC%884%EF%BC%89%EF%BC%9A847-855.e2%EF%BC%8E%E2%80%83%20FLANAGAN%E2%80%83C%E2%80%83P%EF%BC%8CKIM%E2%80%83A%E2%80%83S%EF%BC%8CRAMIREZ%E2%80%83J%E2%80%83L%EF%BC%8Cet%E2%80%83al%EF%BC%8E%0ALow%E2%80%83%20rates%E2%80%83of%E2%80%83aortic%E2%80%83%20surveillance%E2%80%83imaging%E2%80%83and%E2%80%83clinical%E2%80%83%0Afollow-up%E2%80%83in%E2%80%83patients%E2%80%83with%E2%80%83acute%E2%80%83aortic%E2%80%83dissection%EF%BC%BBJ%EF%BC%BD%EF%BC%8E%0AJ%E2%80%83Vasc%E2%80%83Surg%EF%BC%8C2025%EF%BC%8C81%EF%BC%884%EF%BC%89%EF%BC%9A847-855.e2%EF%BC%8E
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