摘要
背景与目的:腹主动脉瘤(AAA)是血管外科常见的动脉扩张性疾病,其最严重的并发症为瘤体破裂,常引发致命性大出血,严重威胁患者生命安全。腹主动脉瘤腔内修复术(EVAR)因其微创、安全、恢复快的优势,已成为AAA的首选治疗方式。然而,术后特有的内漏并发症仍是当前临床面临的主要难题。内漏可致瘤腔持续高压,增加瘤体扩张及破裂风险,是EVAR术后二次干预率较高的主要原因之一,尤其Ⅱ型内漏的处理策略尚存争议。本研究旨在评估在标准EVAR术中联合经髂动脉入路选择性瘤囊栓塞技术治疗即刻内漏的临床应用价值。方法:回顾性收集2023年3月—2024年9月在中国医科大学附属第一医院接受标准EVAR治疗并有内漏风险的AAA患者临床资料。根据是否实施术中经髂动脉入路选择性瘤囊栓塞分为干预组(42例)与未干预组(32例),比较两组患者的一般资料、术前AAA解剖学特征、手术细节及术后随访结果。结果:两组患者在年龄、性别、解剖特征、破裂率及超说明书使用比例等方面差异无统计学意义(均P>0.05)。两组术中技术成功率均为100%。干预组1例术后出现一过性乙状结肠缺血,经保守治疗好转。平均随访时间为(6.49±4.68)个月,干预组瘤囊缩小、稳定及增大比例分别为40.5%、57.1%和2.4%,未干预组分别为59.4%、40.6%和0.0%,两组间差异无统计学意义(均P>0.05)。随访期间内漏发生率在两组间亦无明显差异(P>0.05)。结论:对于标准EVAR术中出现的内漏,经髂动脉入路选择性瘤囊栓塞技术操作简便、安全,短期疗效与术中无内漏者相当,值得临床推广。其远期疗效仍需进一步随访验证。
Background and Aims:Abdominal aortic aneurysm(AAA)is a common arterial dilation disease in vascular surgery,with aneurysm rupture being its most serious complication,often leading to fatal hemorrhage and posing a severe threat to patients'lives.Endovascular aneurysm repair(EVAR),due to its minimally invasive nature,safety,and rapid recovery,has become the preferred treatment for AAA.However,endoleak,a complication unique to EVAR,remains a major clinical challenge.Persistent endoleak can lead to sustained high pressure within the aneurysm sac,increasing the risk of continued expansion and rupture.It is one of the main causes of the high reintervention rate following EVAR.In particular,the treatment strategy for typeⅡendoleaks remains controversial.This study was conducted to evaluate the clinical value of selective sac embolization via the iliac approach combined with standard EVAR in managing intraoperative immediate endoleaks.Methods:The clinical data of AAA patients with a risk of endoleak who underwent standard EVAR at the First Hospital of China Medical University between March 2023 and September 2024 were retrospectively collected.Patients were divided into an intervention group(n=42)and a non-intervention group(n=32)based on whether selective sac embolization via the iliac approach was performed during operation.General clinical data,preoperative anatomical characteristics of the AAA,surgical details,and postoperative follow-up results were compared between the two groups.Results:There were no statistically significant differences between the two groups in terms of age,sex,anatomical features,rupture rate,or off-label use(all P>0.05).The technical success rate during surgery was 100%in both groups.One patient in the intervention group experienced transient sigmoid colon ischemia after operation,which resolved with conservative treatment.The mean follow-up period was(6.49±4.68)months.The proportions of aneurysm sac shrinkage,stability,and enlargement in the intervention group were 40.5%,57.1%,and 2.4%,respectively,compared to 59.4%,40.6%,and 0.0%in the non-intervention group,with no statistically significant differences(all P>0.05).The incidence of endoleak during follow-up was also comparable between the two groups(P>0.05).Conclusion:For intraoperative endoleaks during standard EVAR,selective sac embolization via the iliac approach is a technically simple and safe method that provides short-term outcomes comparable to those in patients without intraoperative endoleaks.Its long-term efficacy warrants further investigation through extended follow-up.
作者
刘琛
卫育鹏
庞利伟
王实跃
刚清伟
姜晗
伦语
张健
LIU Chen;WEI Yupeng;PANG Liwei;WANG Shiyue;GANG Qingwei;JIANG Han;LUN Yu;ZHANG Jian(Department of Vascular Surgery,the First Hospital,China Medical University,Shenyang 110001,China)
出处
《中国普通外科杂志》
北大核心
2025年第6期1139-1148,共10页
China Journal of General Surgery
关键词
主动脉瘤
腹
血管内操作
内漏
栓塞
治疗性
Aortic Aneurysm,Abdominal
Endovascular Procedures
Endoleak
Embolization,Therapeutic
