摘要
目的 观察腔内修复术（EVAR）治疗腹主动脉瘤（AAA）的临床疗效,探讨其术后并发症的原因及治疗经验.方法 对2008年1月至2016年10月在常州市第一人民医院血管外科进行EVAR的70例肾下型AAA患者资料和随访情况进行分析.结果 68例患者EVAR手术技术成功,成功率97.1％,2例（2.9％）术后持续性内漏接受再次手术.术后1个月内死亡3例（4.3％）.术后发现原发性内漏10例（14.3％）,其中Ⅰ型内漏8例（11.4％,Ⅰa型7例,Ⅰb型1例）,Ⅱ型内漏2例（2.9％）;2例Ⅰ型内漏（Ⅰa、Ⅰb型各1例）分别于术后第3日、6个月再次手术,8例随访中自愈.继发内漏4例（5.7％）,均经弹簧圈栓塞加覆膜支架治愈.发生臀肌跛行18例（25.7％）,经扩血管祛聚等治疗后症状减轻.穿刺入路侧下肢缺血2例（2.9％）,1例行股-股转流后症状消失,1例自动出院.随访2～66个月,平均（7.9±12.8）个月,术后1年内死亡5例（7.1％）;3年内死亡7例（17.5％）.结论 内漏致动脉瘤体增大是EVAR治疗AAA最严重的早中期并发症,尽早发现并处理其潜在的危险因素能有效提高远期生存率.
Objective To survey the clinical results of endovascular repair for abdominal aortic aneurysm, and to discuss the reasons and treatment experiences of complications after surgery. Methods 70 patients with infrarenal abdominal aortic aneurysms were treated by endovascular repair and followed up, these clinical data were retrospectively analyzed. Results 68 cases of the endovascular aortic repair （EVAR） were successfully implemented, primary technical success rate was 97.1%. 2 patients accepted the additional surgeries for persistent endoleaks after EVAR. 3 patients （4.3%） died in a month, respectively for upper gastrointestinal hemorrhage, multiple organ failure and cerebral infarction. 10 cases （14.3%, 7 with type Ⅰ a, 1 with type Ⅰ b, 2 with type Ⅱ ） of primary endoleaks after surgery occurred, 2 patients （2.9%, 1 with type Ⅰ a, 1 with type Ⅰ b） received secondary surgery respectively after 3 days and 6 months , the endoleaks of the rest 8 patients disappeared spontaneously on follow-up. There were 4 cases （5.7%） of secondary endoleaks after surgery, all of them were eliminated by coil embolism and covered-stent. 18 cases （25.7%） of gluteus claudication occurred, all of them were relieved by drug therapies including vascular dilation and platelet aggregation inhibitor. Low limb iscbemia was observed in 2 cases （2.9%） on operation side, one was cured by bypass, the other patient left hospital spontaneously. All cases were followed up for 2 to 66 months （mean 7.9±12.8 months）, 5 cases （7.1%） died in 1 year; 7 cases （17.5%） died in 3 years. Conclusion The aneurysmal sac enlargement owing to instant endoleak is the most dangerous complication in short and midterm follow-up period of EVAR for AAA. Early detection and solution for the potential risk factors will effectively improve the long-term survival rate.
作者
葛红卫
朱云峰
朱永斌
吴元兵
姜云飞
黄一鸣
李丹丹
陈诚
王鑫
Ge Hongwei;Zhu Yunfeng;Zhu Yongbin;Wu Yuanbing;Jiang Yunfei;Huang Yiming;Li Dandan;Chen Cheng;Wang Xin.(Department of Vascular Surgery, The First People＇s Hospital of Changzhou, Changzhou 213003, China)
出处
《中华血管外科杂志》
2018年第1期27-31,共5页
Chinese Journal of Vascular Surgery
关键词
主动脉瘤
腹
腔内修复
内漏
并发症
Abdominal aortic aneurysm
Endovascular repair
Endoleak
Complication
