摘要
腔内修复(EVAR)术后腹主动脉瘤(AAA)破裂是严重的主动脉疾病,危及生命。随着EVAR手术的推广和病人预期生命延长,发现其术后远期发生率显著高于预期。提高EVAR术后长期随访率,同时重视动脉粥样硬化和系统性炎性疾病对EVAR手术远期预后的意义,有助于早期发现AAA破裂风险,降低发生率。该疾病须根据病人病情制定个体化的手术治疗方案,但总体的围手术期病死率高。腔内手术是首选的手术治疗方法,以"Cuff开窗技术"、"裙套技术"为代表的腔内手术能够快速、有效地隔绝内漏;开放手术是治疗复杂病变的重要手段,以"球囊阻断技术联合主动脉缩缝术"为代表的开放手术,能够迅速稳定血流动力学状态,彻底纠正主动脉破裂的病变,有较高的救治成功率。
Rupture of abdominal aortic aneurysm(AAA)after endovascular aortic repair(EVAR)is a life-threatening aortic disease.With the development and spread of EVAR and the increasing of the expected life of the AAA patient after EVAR,the incidence of AAA rupture after EVAR increases obviously,which is much higher than expectation of the researches previously.In order to detect the risk of AAA rupture,the effective long-term follow-up and the pathogenesis of AAA,especially atherosclerosis and systematic inflammatory disease,which are significant to the long-term complications of AAA after EVAR,should be given greater prominence.The surgical treatment strategy of the disease should be made individually according to the specific pathogenesis and anatomic situation.However,the pooled estimate for perioperative mortality is high.Endovascular method is the preferred treatment.The technique with fenestrations on a cuff stent graft can be used to seal type Ia endoleak with a complicated proximal landing zone.The"skirt technique"is an effective method in the treatment of typeⅠb endoleak caused by a common/internal iliac aneurysm.Open surgery is used for the patient with complicated anatomic situations.The aortic contraction surgery associated with the technique of aortic interruption with a compliant aortic balloon is an effective and reliable method to keep hemodynamics stable and cure aortic rupture.
作者
王暾
李全明
何昊
舒畅
黎明
李鑫
WANG Tun;LIQuan-ming;HE Hao;SHU Chang(Department of Vascular Surgery,the Second Xiangya Hospital,Central South University,Changsha 410011,China)
出处
《中国实用外科杂志》
CSCD
北大核心
2020年第12期1359-1363,共5页
Chinese Journal of Practical Surgery
基金
中国医学科学院医学与健康科技创新工程(重大协同创新项目)基金资助项目(No.2016-I2M-1-016)
关键词
腔内修复
腹主动脉瘤
主动脉破裂
开放手术
endovascular aortic repair
abdominal aortic aneurysm
aortic rupture
open surgery
