摘要目的:探讨应用3D打印技术指导开窗/分支支架技术（fenestrated /branched endovascular repair，F/B-EVAR）血管腔内修复胸腹主动脉疾病的经验。方法:回顾性分析2018年2月至2023年3月全国范围内69家医疗中心采用3D打印技术指导医师自制支架行F/B-EVAR修复胸腹主动脉病变共316例患者的临床及随访资料。结果:本组中位随访时间23个月（2~60个月），随访丢失24例，随访率92.4%（292/316），平均术后住院时间（8.2±4.9）d，共重建胸腹主段分支动脉944条。术中11条分支动脉重建失败，成功率98.8%（933/944）。术后30 d内，死亡8例，死亡率2.5%，随访中死亡6例，共死亡14例，死亡率4.4%（14/316）。脊髓缺血11例（3.5%），无永久性截瘫。术后肾功能损伤19例（6.0%）。术后26例患者检查中发现内漏，内漏率8.2%。结论:3D打印技术可对分支动脉位置个体化精准定位，同时简化手术流程，缩短学习曲线且临床疗效较佳。

abstractsObjective:To study the application of 3D printing technology in multi-center fenestrated/branched endovascular repair (F/B-EVAR) for endovascular repair of abdominal aortic diseases.Methods:From Feb 2018 to Mar 2023, The clinical and followup data of 316 cases of abdominal aortic lesions undergoing repair with F/B-EVAR at 69 medical centers nationwide using 3D printing technology to guide physician-modified stent graft were retrospectively analyzed.Results:The mean follow-up time of the patients was 23 months (2-60 months), and 24 cases were lost to follow up, the follow-up rate was 92.4% (292/316), the mean postoperative hospitalization time was (8.2±4.9) days. A total of 944 main abdominal branch arteries were reconstructed. Intraoperative reconstruction of 11 branches failed, with a success rate of 98.8% (933/944). Within 30 days after surgery, 8 patients died (2.5%), and 6 patients died during follow-up, a total of 14 patients died (4.4%). There were 11 cases (3.5%) of spinal cord ischemia and no patient suffered from permanent paraplegia. There were 19 patients (6.0%) with postoperative renal function injury. Internal leakage was found in 26 patients, and the rate of internal leakage was 8.2%.Conclusion:3D printing technology can accurately locate the location of branch arteries, simplifing the surgical process, shortening the learning curve , and improving clinical efficacy.