摘要
目的评估在腹主动脉瘤(abdominal aortic aneurysms,AAA)患者中腔内主动脉修复术(endovascular aortic repair,EVAR)中使用α-氰基丙烯酸酯(N-butyl cyanoacrylate,NBCA)预防性栓塞瘤腔以预防Ⅱ型内漏的安全性与有效性。方法对2019年1月至2022年1月期间于甘肃省人民医院进行EVAR的AAA患者进行回顾性分析,严格按照纳入和排除标准,共纳入74例患者,其中36例患者(试验组)在EVAR中行动脉瘤囊内预防性注射NBCA栓塞瘤腔,38例患者(对照组)行标准EVAR治疗。收集上述74例患者的临床资料(年龄、性别、基础疾病、动脉瘤直径、住院费用、手术时长、支架类型、麻醉类型等)。主要终点为随访期间内漏的发生率,次要终点包括随访期间内漏相关的再干预率、不良事件以及死亡率等。结果术前试验组与对照组的性别、年龄、直径[55.46(15.60)mmvs 63.15(24.00)mm]、基础疾病等差异均无统计学意义,术中无并发症,两组技术成功率均为100%。术后3个月时,试验组Ⅱ型内漏的发生率明显低于对照组(2.86%vs 21.05%,P<0.01);6个月时,两组Ⅱ型内漏的发生率分别为(8.82%vs 28.95%,P<0.01);12个月时,两组Ⅱ型内漏的发生率分别为(8.82%vs 31.43%,P<0.01)。试验组中进行了4次再干预,其中1次与Ⅱ型内漏相关,对照组进行了8次再干预,其中6次与Ⅱ型内漏相关,两组总的再干预率差异没有统计学意义(P=0.224),试验组的Ⅱ型内漏相关的再干预率略低于对照组,但差异没有统计学意义(P=0.106)。结论在EVAR中预防性向AAA囊内注射NBCA是一种简单、安全、有效的方法,可显著减少中早期Ⅱ型内漏的发生,防止EVAR后囊增大,对再干预率和死亡率无明显影响,并且没有显著延长手术时间和增加对比剂的剂量。
Objective The efficacy of prophylactic aneurysmal sac embolization is still unclear.The purpose of this study is to evaluate the safety and efficacy of prophylactic aneurysmal sac embolization with N-butyl cyanoacrylate(NBCA)during endovascular aortic repair(EVAR)in patients with abdominal aortic aneurysms(AAA)so as to prevent the occurrence of type Ⅱ endoleak.Methods The clinical data of patients with AAA,who received EVAR from January 2019 to January 2022 at Gansu Provincial Hospital,were retrospectively analyzed.According to the strict inclusion and exclusion criteria,a total of 74 AAA patients were enrolled in this study.Of the 74 AAA patients,intraoperative prophylactic injection of NBCA into the aneurysmal sac to embolize the sac cavity during EVAR was performed in 36(study group),while standard EVAR treatment was carried out in 38(control group).The clinical data of the 74 patients,mainly including age,gender,underlying diseases,diameter of the aneurysm,hospitalization cost,time spent for surgery,type of stent,mode of anesthesia,etc.were collected.The primary endpoint was the incidence of endoleak during follow-up period,and the secondary endpoints included the rate of endoleak-related re-intervention,adverse events,and mortality during follow-up period.Results Before surgery,there were no statistically significant differences in gender,age,diameter of the aneurysm[55.46(15.60)mmvs 63.15(24.00)mm],and underlying diseases between the study group and the control group,and no intraoperative complications occurred.The technical success rate was 100%in both groups.Three months after EVAR treatment,the incidence of type Ⅱ endoleak in the study group was significantly lower than that in the control group(2.86%vs 21.05%,P<0.01);six months after EVAR treatment,the incidence of type Ⅱ endoleak in the study group and the control group was 8.82%and 28.95%respectively(P<0.01);and 12 months after EVAR treatment,the incidence of type Ⅱ endoleak in the study group and the control group was 8.82%and 31.43%respectively(P<0.01).In the study group a total of 4 times of re-intervention were carried out,one of which was associated with type Ⅱ endoleak.In the control group a total of 8 times of re-intervention were conducted,6 of which were associated with type Ⅱ endoleak.No statistically significant difference in the overall re-intervention rate existed between the two groups(P=0.224).The type Ⅱ endoleak-related re-intervention rate in the study group was slightly lower thanl?`l?that in the control group,but the difference was not statistically significant(P=0.106).Conclusion Prophylactic injection of NBCA into the aneurysmal sac cavity of AAA during EVAR procedure is a simple,safe and effective method,which can significantly reduce the occurrence of type Ⅱ endoleak in the early-middle stage and prevent the enlargement of the aneurysmal sac after EVAR,besides,it has no significant effect on the reintervention rate and mortality,does not significantly prolong the operation time,and does not increase the dosage of contrast agent.
作者
张原
石朝海
王亮
陈泉
ZHANG Yuan;SHI Chaohai;WANG Liang;CHEN Quan(Department of Intervention and Vascular Surgery,Tenth Affiliated Hospital of Southern Medical University(Dongguan Municipal People′s Hospital),Dongguan,Guangdong Province 523000,China)
出处
《介入放射学杂志》
北大核心
2025年第7期736-742,共7页
Journal of Interventional Radiology
基金
东莞市人民医院博士启动资金(K202411)
东莞市医学领军人才项目(DGYXLJ0001)。
关键词
腹主动脉瘤
内漏
栓塞
Α-氰基丙烯酸酯
abdominal aortic aneurysm
endoleak
embolization
N-butyl cyanoacrylat
