摘要
目的探讨国内肾下型腹主动脉瘤（IAAA）腔内修复术（EVAR）术后脊髓缺血（SCI）并发症的发病率及其可能的病因机制。方法回顾2008年1月至2014年10月在第二军医大学长海医院及长征医院血管外科收治的400例行EVAR的IAAA病例,分析EVAR术中髂内动脉封堵及术后SCI发生情况。结合现有文献资料,回顾分析EVAR术后SCI的发病率及可能的病因机制。结果术中同期封堵双侧髂内动脉60例（8例同期弹簧圈栓塞单侧髂内动脉瘤）,封堵单侧髂内动脉70例（10例同期弹簧圈不完全栓塞髂内动脉瘤）。术后急性下肢动脉缺血2例,急性SCI 1例,慢性下肢间跛1例（〉3个月）,SCI发病率为0.25%（1/400）。总结现有文献,EVAR术后SCI发病率为0.21%-0.38%,14例SCI病例中仅1例明确可能与术中髂内动脉栓塞有关。结论 SCI是IAAA EVAR术后极为罕见的并发症,目前机制尚未明确。术中同期封堵髂内动脉在其中可能起到一定作用,但目前资料及文献可能更倾向于非核心作用的观点。除脊髓血供血管封堵、栓塞造成的缺血原因外,围手术期患者一般情况也需考虑在内。
Objective To explore the morbidity and possible mechanism of spinal cord ischemia （SCI） after infrarenal abdominal aortic aneurysm （IAAA） endovascular aneurysm repair （EVAR）. Methods We retrospectively analyzed the intraoperative hypogastric artery occlusion and postoperative SCI of 400 patients who received EVAR in the Departments of Vascular and Endovaseular Surgery of Shanghai Changhai Hospital and Changzheng Hospital from January 2008 to October 2014. The morbidity and possible mechanism of SCI after EVAR were analyzed while combining the existing literatures. Results Bilateral hypogastric arteries were obstructed during operation in 60 patients （unilateral hypogastric artery aneurysms were embolized by spring coil in 8 cases） ; unilateral hypogastric arteries was obstructed in 70 patients （unilateral hypogastric artery aneurysms were partially embolized by spring coil in 10 cases）. Postoperatively 2 cases had acute lower limb artery ischemia, 1 had acute SCI, and 1 had chronic lower limb lameness（〉 3 months）. The incidence of SCI was 0. 25%（1/400）. Existing literatures showed that the incidence of SCI following EVAR was 0. 21%-0. 38%, and only 1 of the 14 cases with SCI was thought to be associated with the hypogastric artery＇s interruption. Conclusion SCI is a very rare postoperative complication of EVAR, with the mechanism remaining unknown. The occlusion of hypogastric artery may play a part, but existing literatures suggest a noncore role. In addition to ischemia caused by SCI and embolization, the perioperative general condition of patients also needs to be taken into consideration.
出处
《第二军医大学学报》
CAS
CSCD
北大核心
2016年第3期375-378,共4页
Academic Journal of Second Military Medical University
关键词
肾下型腹主动脉瘤
动脉瘤腔内修复术
脊髓缺血
脑脊液引流
inffarenal abdominal aortic aneurysm
endovascular aneurysm repair
spinal cord ischemia
eerebrospinal fluid drainage
