摘要
目的 总结腹主动脉瘤腔内治疗的初步经验。方法 根据术前影像学资料设计合理支架型血管 ;经股动脉在透视下将移植物放置在腹主动脉瘤腔内重建血流通道 ;术后严格按照预期方案进行随诊 ,观察并发症及瘤体形态学变化。结果 34例接受腔内治疗的腹主动脉瘤技术成功率1 0 0 %。无中转开腹手术。原发性内漏 5例。神经并发症合并急性血栓形成 1例。无肾动脉梗塞、肢体栓塞、结肠缺血等并发症。随访时间 1 2～ 40个月 ,平均随访时间 2 1± 4 .7个月。围手术期死亡率0 % (0 /34) ,总死亡率 3 % (1 /34)。随访过程中发现 2例原发性内漏转为持续性内漏 ,另发现继发性内漏 2例。本组患者 1个月后内漏发生率 1 1 .7% (4/34)。 1例髂动脉支架滑脱经二期腔内治疗。无内漏患者平均瘤体最大直径术后 6个月、1 2个月、2年较术前有明显缩小 (P <0 .0 1 )。 2例继发性Ⅰ型内漏随访中瘤体增大 ,1例进行二期腔内治疗。结论 血管腔内技术治疗腹主动脉瘤是一种可靠的微创治疗手段。内漏血是该技术主要并发症。随访工作是整个治疗工作中的重要组成部分。瘤腔被完全旷置。
Objective To summarize the initial experience of endoluminal stent grafting in the treatment of abdominal aortic aneurysm (AAA). Methods Stent graft of proper shape and size was selected according to the morphology of AAA and was inserted into the lumen of abdominal aortic aneurysm through femoral artery to reconstruct the blood flow under X ray flouroscopy among 34 cases. Data on complications and morphological changes were obtained according to a strict follow up plan. Results The stent grafting procedure was technically successful in all 34 patients. None of them required open repair. Five patients (14.7%) suffered from primary endoleaks after stent graft deployment and 1 patient suffered from paraplegia and acute graft thrombosis. No other complications (kidney infarction, limbs and colon ischemia, etc) were found. The average follow up time was 21± 4.7 months. Perioperative death rate was 0% and total death rate was 3%. Two cases with primary endoleak developed into lasting endoleak during the follow up period with a rate of late endoleak (>30 days) of 11.7%. Secondary endoleak was found in 2 cases. One case with limb stent disconnection accepted secondary intervention. The mean max aneurysm diameter in cases without endoleak decreased significantly 6 months to 2 years after operation ( P <0.01). The aneurysm in two cases with secondary typeⅠendoleak increased and one of them underwent secondary intraluminal treatment. Conclusion Endovascular technique is a reliable method of treating AAA with micro trauma. Endoleak is the main complication of this technique. Follow up is an important component of the treatment plan. The aim of endoluminal repair is to completely neglect the aneurysmal lumen and prevent the aneurysm from increasing during follow up.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2002年第5期291-293,共3页
National Medical Journal of China
基金
军队九五医药卫生重点课题基金资助项目( 97Z0 6 0 )
