腹主动脉瘤大小对腔内隔绝术及其疗效的影响  

Effect of the size of abdominal aortic aneurysm on endovascular exclusion and its results

作　　者：袁良喜[1] 包俊敏[1] 赵志青[1] 曲乐丰[1] 冯翔[1] 陆清声[1] 冯睿[1] 梅志军[1] 裴秩飞[1] 景在平[1] 

机构地区：[1]第二军医大学附属长海医院血管外科全军血管外科研究所,上海200433

出　　处：《中华外科杂志》2008年第6期420-422,共3页Chinese Journal of Surgery

基　　金：国家十一五“863”计划基金资助项目（2006AA0224E2）;上海市卫生系统百名跨世纪优秀学科带头人计划基金（97BR047）;军队“十五”重大临床技术攻关项目（31070926）

摘　　要：目的探讨腹主动脉瘤大小对腔内隔绝术及隔绝后治疗结果的影响。方法回顾性分析1997年3月至2007年6月共429例腹主动脉瘤的临床资料，依腹主动脉瘤直径将患者分为〈55mm组（A组，n=274）及≥55mm组（B组，n=155）。根据术前影像学资料研究两组动脉瘤大小、瘤颈长度、瘤颈直径、瘤颈扭曲程度及髂动脉是否受累等，并探讨动脉瘤大小对腔内隔绝术及治疗结果的影响。结果A组平均年龄71．1岁，B组73．7岁（P〈0．05）。B组有冠心病史者（36．1％）明显多于A组（18．6％）（P〈0．05），B组伴高血压病、糖尿病、慢性阻塞性肺疾病者多于A组，但两组间差异无统计学意义。A组腹主动脉瘤平均直径为（46．6±6．8）mm，B组为（66．8±11．2）mm（P〈0．05）；B组腹主动脉瘤较A组近端瘤颈短、瘤颈直径大、瘤颈扭曲、易累及髂动脉（P〈0．05）；B组患者应用腹膜外径路、髂内动脉重建或髂内动脉栓塞等附加手术、术中牵张导丝均多于A组，术中发生内漏数及使用移植物个数均高于A组（P〈0．05）。围手术期并发症发生率B组高于A组，病死率无明显差异。术后B组内漏率及二次干预率均高于A组。结论腔内隔绝术治疗腹主动脉瘤获得了较好的临床效果，而腹主动脉瘤的大小对腔内隔绝术存在一定影响，较小腹主动脉瘤无论在术中操作、围手术期并发症、术后随访等方面均优于较大腹主动脉瘤。Objective To evaluate the effect of the diameter of abdominal aortic aneurysm （AAA） on endovascular exclusion （EVE） and its results. Methods From March 1997 to June 2007, 429 AAA patients were treated with endovascular stent-graft exclusion. According to the maximal diameter of abdominal aortic aneurysm, the patients were divided into two groups ： group A （ diameter 〈 55 mm, n = 274） and group B （ diameter≥55 mm, n = 155 ）. The diameter of AAA, involvement of iliac artery, length, diameter and distortion of aneurismal neck in the two groups were recorded and compared retrospectively. Results Patients in group B were significantly older than group A （73.7 vs 71.1 years, P 〈 0. 05 ）. More patients in group B was complicated with coronary artery disease than those in group A （ P 〈 0. 05 ）. The mean diameter of AAA in group A was （46. 6 ± 6. 8 ） mm, and （ 66. 8 ±11.2 ） mm in group B （ P 〈 0. 05 ）. Proximal aneurysmal necks were shorter, wider and more tortuous in group B than those in group A （P 〈 0. 05 ）. Extraperitoneal approach, embolism of inner iliac artery and reconstruction of another inner iliac artery and stretch technique were more applied in group B. There were more endoleak during operation in group B and more stent-grafts were used. There was significant difference in morbility rate between the two groups, while no statistic difference in mortality. And in group B, there were a high rate of endoleak and secondary intervention post operation. Conclusions The diameter of AAA affects EVE and its results. In small aneurysms, EVE carries better outcome than in big aneurysms.

关 键 词：主动脉瘤 腹 腔内隔绝术 预后 

分 类 号：R686[医药卫生—骨科学]