摘要
目的：总结应用腔内修复术治疗腹主动脉瘤的经验，探讨内漏的防治策略。方法：回顾性分析齐鲁医院及莱钢医院2007年1月-2012年12月接受腔内治疗的43例肾下型腹主动脉瘤患者临床资料，分析内漏的发生原因、预防和处理。结果：术后发生原发性内漏11例，其中I型8例，Ⅲ型2例；植入分叉型支架发生9例，植入直管型支架发生2例。1例Ⅱ型因漏血量小未处理；经一期经过球囊扩张、植入支架型血管或裸支架等处理后，除2例I型内漏仍有残留，其余I，Ⅲ型内漏均消失。39例患者获随访4～50个月，发现迟发性Ib型、Ⅱ型内漏各2例，继续随访1～2年，未见瘤体明显增大。3例残留原发性内漏自愈，术后半年复发Ia型内漏1例，导致动脉瘤复发破裂而再次接受腔内治疗。结论：内漏的发生与动脉瘤的解剖学条件、移植物缺陷和操作技术有关；防治内漏需要把握好手术适应证、合理选择支架，并有成熟的操作经验。
Objective： To investigate the prevention and treatment of endoleak by summarizing our experience of endovascular aneurysm repair. Methods： The clinical data of 43 patients with infrarenal abdominal aortic aneurysm undergoing endovascular repair （EVAR） from January 2007 to December 2012 in Qilu Hospital and Laiwu-Steel Company Hospital were analyzed retrospectively, The causes, prevention and treatment of endoleak were analyzed. Results： Pimary endoleak after intervention occurred in 11 patients, of whom, 8 cases were type I, 1 case wastype Ⅱ, and 2 cases were type Ⅲ; 9 cases underwent bifurcated stent-graft implantation and 2 cases underwent tubular stent-graft implantation. The one type Ⅱ endoleak was not treated because the leak was small; after first-stage balloon dilatation or stent-graft implantation 2 cases of type I endoleaks still existed, but all the other type I and Ⅲ endoleaks were resolved. Thirty-nine patients were followed up. During the period of 4 to 50 months of follow-up, 2 delayed type Ib and 2 delayed type II endoleaks were found, but the aneurysms did not enlarge during the following 1- to 2-year follow-up period. The residual primary endoleak in 3 cases spontaneously disappeared, but type Ia endoleak recurred in 1 case 6 months after operation, which caused the aneurysm recurrence and rupture and a second endovascular repair. Conclusion： The occurrence of endoleak is related to anatomic condition, stent defects and surgical skill. Prevention and treatment of endoleaks require a good grasp of surgical indications, reasonable choice of stent, and mature operating experience.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2013年第12期1548-1552,共5页
China Journal of General Surgery
关键词
主动脉瘤
腹
腔内修复术
内漏
预防和控制
Aortic Aneurysm, Abdominal
Endovascular Aneurysm Repair
Endoleak/prev
