EVAR术后Ⅱ型内漏相关动脉的应用解剖学研究  

Applied anatomy of the type Ⅱ endoleak relevant arteries after endovascular aneurysm repair

作　　者：郭发才[1] 代远斌[2] 徐强[2] 

机构地区：[1]兰州大学第二医院血管外科,兰州730030 [2]重庆医科大学附属第一医院血管外科,重庆400016

出　　处：《中国临床解剖学杂志》2012年第1期17-21,共5页Chinese Journal of Clinical Anatomy

摘　　要：目的为栓塞EVAR术后Ⅱ型内漏侧支或(和)瘤囊提供解剖学依据。方法在30具成人尸体标本(男性18具,女性12具)上对肠系膜上下动脉、腰动脉、骶正中动脉、髂内动脉、髂腰动脉及可能出现的副肾动脉的始端外径、位置、走行、距主动脉分叉距离及与相关夹角进行观测和统计学分析;并对其临床意义进行初步讨论。结果肠系膜上动脉、肠系膜下动脉均起自腹主动脉前壁,位置固定,变异较少,矢状位与腹主动脉夹角分别为50°,23°;所有标本中边缘动脉均完整、无变异或缺如,未发现Riolan弓;观测中发现2例有副肾动脉,出现率6.7%,起始及发起高度变异较大;腰动脉、骶正中动脉的数量以及位置相对固定,腰动脉位置对应其椎体稍下方走行,与髂腰动脉有吻合现象;髂内、外动脉夹角甚小(26°)或为0°,两者几乎平行下降。结论掌握EVAR术后Ⅱ型内漏的反流动脉解剖学特点的是插管栓塞治疗的先决条件,术中应根据Ⅱ型内漏的反流动脉分布、吻合变异情况选择不同的栓塞途径和方法,以获得较好的治疗效果。Objective To provide anatomic basis for transarterial embolization or transcaval embolization type Ⅱ endoleak after endovascular aneurysm repair（EVAR）.Methods The outer diameters of the beginning end,position,tendency,distance to abdominal aorta furcation and relevant included angle of the following arteries of 30 adults corpses（18 male,12 female） were observed and analyzed statistically： the superior mesenteric artery（SMA）and inferior mesenteric artery（IMA）,lumbar artery（LA）,median sacral artery,internal iliac artery,iliolumbar artery and accessory renal artery possibly appearing,and the clinical significance was initially discussed. Results Both SMA and IMA originated from the anterior aortic wall with fixed location and less variation.Their included angels with abdominal aorta were respectively 50° and 23°.For all the specimens,the marginal arteries were observed without variation and absence,however,arc of Riolan was not found.Accessory renal arteries were observed in 2 bodies（frequency： 6.7%） with big differences in the beginning and originating height.The number and location of the lumbar artery and median sacral artery were relatively fixed.The lumber artery had the same tendency with the inferior part of its vertebral body and anastomosed with the iliolumbar artery.The included angel of the internal and external iliac artery was small（26°）or even 0°with almost parallel descent.Conclusions Understood the anatomy characteristics of patent sac contraflow artery due to transarterial embolization type Ⅱ endoleak,were the precondition of transarterial embolization treatment.In order to get better therapeutic efficacy,different embolization channels and methods are suggested to be chosen on the basis of the distribution and anastomosis variation of patent sac contraflow artery of type Ⅱ endoleak.

关 键 词：Ⅱ型内漏 肠系膜下动脉 肠系膜上动脉 腰动脉 经动脉栓塞 Riolan弓 应用解剖 

分 类 号：R654.3[医药卫生—外科学]