腔内人造血管内支撑术治疗腹主动脉瘤  

Endoluminal grafting for treatment of abdominal aortic aneurysms

作　　者：符伟国[1] 王玉琦[1] 陈福真[1] 叶建荣[1] 王建华 颜志平[2] 程洁敏 

机构地区：[1]上海医科大学中山医院血管外科,200032 [2]上海医科大学中山医院血管放射科,200032

出　　处：《中华放射学杂志》2000年第5期338-341,共4页Chinese Journal of Radiology

基　　金：上海市卫生系统首批"百人计划"培养基金!97BR028

摘　　要：目的评价腔内人造血管内支撑术治疗腹主动脉瘤的早期临床疗效。方法自1998年2月至1999年2月，根据6例腹主动脉瘤患者三维重建螺旋CT和动脉造影结果，于术前对每个腹主动脉瘤近远端的瘤颈长度、直径和角度，以及动脉瘤和骼总动脉、馆外动脉本身的直径等主要参数进行测量，动脉瘤直径为4．6～8．0cm，平均6．3cm；肾动脉下腹主动脉直径为1．8～2．2cm，平均2．0cm；近端瘤颈长度为2．5～3．5cm，平均3．0cm。6例均采用经腹股沟切口腹主动脉瘤腔内人造血管内支撑术。4例选用Vanguard分叉型腔内人造血管，2例选用Vanguard直型腔内人造血管。结果6例患者术后即刻DSA造影显示动脉瘤消失，近远端人造血管与宿主动脉结合处均未见渗漏。5例患者术后生命体征平稳，1例因手术时间过长、术中反复造影，导致术后急性肾功能衰竭和多脏器功能衰竭，于术后第3天死亡。5例患者术后1周行螺旋CT扫描随访，2例术后3个月、1例术后12个月分别行螺旋CT扫描和彩色超声显像随访，显示人造血管无移位，无渗漏，动脉瘤腔无增大。结论近期随访表明，腔内人造血管内支撑术是一种创伤小、安全有效、恢复快的治疗腹主动脉瘤的新方法，但远期疗效还有待继续随访。Objective To evaluate the preliminary clinical results of endovascular procedures for abdominal aortic aneurysms(AAA)in a prospective study. Methods Six patients (average age 70 yeare, range 56 to 78) with infrarenal AAA were enrolled in Shanghai Zhongshan hospital from February 1998 to February 1999.Computed tomography and angiography were done in every patient for measurement of the length, diameter, and angulation of the proximal and distal AAA necks, aneurysm sac, and common and external iliac arteries. The average diameter of the aneurysm was 6.3 cm (range 4.6 cm to 8.0 cm).The mean proximal neck diameter was 2.0 cm (range 1 .8 cm to 2.2 cm) and proximal neck length was 3.0 cm (rang 2.5 cm to 3.5 cm). All patients were treated with the endoluminal grafting for exclusion of AAA. Results Two tubular and 4 bifurcated endografts were used. All endograft procedures were completed successfully. One patient died of renal failure 72 haurs after the procedare because of the prolonged operative time and excessive contrast medium. Aortography after the procedure showed the AAA were excluded by endograft and no endoleak in the proximal or distal connections was dstected The patients could take meal and were ambulatory on the firs and second postoperative day,respectively. Clinical success (aneurysm exclusion with no death or endoleak) at 30 days was 83.3%. In the 24 months follow-up in 5 cases, no migration, endoleak, and increasing aneurysm size were detected with spiral CT or color Duplex ultrasound. Conclusion Based on initial results and a short term mean follow-up peried of 24 months, the endovascular treatment of AAA with stent-graft system is feasible and safe. Further study will be required to observe the long term result in the excusion of AAA.

关 键 词：腹主动脉瘤 人工血管 介入性 内支撑术 

分 类 号：R730.5[医药卫生—肿瘤]