腹主动脉瘤患者腔内修复术后Ⅱ型内漏的处理分析  

Treatment of type Ⅱ endoleak after abdominal aortic aneurysm endovascular repair

作　　者：杜昕[1] 郭伟[1] 刘小平[1] 贾鑫[1] 张敏宏[1] 尹太[1] 张宏鹏[1] 马晓辉[1] 熊江[1] 

机构地区：[1]解放军总医院血管外科,北京100853

出　　处：《中华医学杂志》2011年第42期2955-2958,共4页National Medical Journal of China

基　　金：首都医学发展科研基金（2007-1027）

摘　　要：目的探讨腹主动脉瘤腔内修复术（EVAR）后Ⅱ型内漏的处理。方法选择解放军总医院血管外科2009年1月至2011年7月10例确诊肾下腹主动脉瘤EVAR术后Ⅱ型内漏的病例，根据内漏罪犯血管不同，选择腔内途径超选择栓塞结合CT引导下经皮穿刺瘤腔内注射纤维蛋白胶进行治疗，并随访观察。结果10例患者中9例接受治疗，8例接受随访，平均随访时间（2．4±1．6）个月（1～6个月），二次干预年限平均（62±39）个月（11～132个月）；罪犯血管肠系膜下动脉来源3例，2例经肠系膜上动脉人路弹簧圈栓塞治疗，1例未治；髂内动脉来源1例，髂内动脉一腰动脉来源3例，均经弹簧圈栓塞；腰动脉来源3例，2例经皮穿刺球囊内注射治疗，1例弹簧圈栓塞。随访期因心脑血管意外死亡2例；初期技术成功率44％，再干预率33％，总体治疗有效率89％。结论腹主动脉瘤腔内修复术后Ⅱ型内漏整体自然预后较温和，对造成瘤体持续显著增长者可积极干预，腔内栓塞结合瘤腔内注射术是一种近期效果尚可。Objective To explore the treatment of type Ⅱ endoleak （TEE） after the endovascular aneurysm repair （EVAR） of abdominal aortic aneurysm （ AAA ）. Methods From January 2009 to July 2011, 10 patients with type Ⅱ endoleak after AAA EVAR were recruited. Different treatment methods were employed for the criminal arteries, including transcatheter embolization with coils, percutaneous sac puncture, intrasac injection of fibrin glue and outcome follow-up. Results Among them, 9 patients underwent treatment and 8 received a mean follow-up of （2.4 ±1.6） months. The mean secondary time was （62± 39 ） months. The criminal arteries were inferior mesenteric artery （ n = 3 ）, internal iliac artery （IA） （ n = 1 ）, IA with lumbar artery （ n = 3 ） and lumbar artery （ n = 3 ）. Two patients died from cardiovascular and cerebrovascular events during the follow-up. The primary technical success was 44% , retreat rate 33% and clinical success rate 89%. Conclusion Type Ⅱ endoleak has a relatively benign course. In the absence of sac expansion, it can be followed for a long period of time without the needs for intervention. Treatment is necessary when it persists beyond 12 months or when there is a significant increase in aneurysm sac diameter.

关 键 词：动脉瘤 腹主动脉 腔内修复 内漏 

分 类 号：R654.3[医药卫生—外科学]