腔内人造血管内支撑术在血管外科中的应用  

The clinical application of endovascular techniques for management of vascular diseases.

作　　者：符伟国[1] 王玉琦[1] 陈福真[1] 叶建荣[1] 郭大乔[1] 陈斌[1] 杨珏[1] 

机构地区：[1]上海医科大学中山医院血管外科,200032

出　　处：《中国实用外科杂志》2000年第3期156-158,I000,共4页Chinese Journal of Practical Surgery

基　　金：上海市卫生系统"百人计划"培养基金!资助 批号 :97BR0 2 8

摘　　要：目的　评价腔内人造血管内支撑术在治疗血管外科疾病中的早期临床疗效。方法　 9例病人接受腔内人造血管内支撑术治疗。其中腹主动脉瘤 6例 ,左锁骨下动脉瘤 1例 ,左髂总动静脉瘘 1例 ,左髂股动脉重度硬化性狭窄 1例。术前均行Duplex彩超、四肢节段性测压 (PVL)和DSA造影 ,6例动脉瘤病人术前行三维重建螺旋CT。结果　术后即刻DSA造影显示 ,7例动脉瘤消失 ,近远端人造血管与宿主动脉结合处均未见渗漏 ;1例左髂动静脉瘘及瘤体消失 ;1例左髂股动脉重度狭窄消失 ,人造血管通畅 ;1例腹主动脉瘤因急性肾功能衰竭于术后第 3天死亡。临床成功率 88 88%。术后 1年螺旋CT或Duplex随访显示 :5例腹主动脉瘤和 1例髂总动静脉瘘腔内人造血管无移位 ,无渗漏 ,动脉瘤腔无增大 ;1例左髂股动脉重度狭窄术后间歇性跛行消失 ;1例锁骨下动脉瘤术后存在少量渗漏 ,2个月后自行闭合。结论　近期随访表明 ,腔内人造血管内支撑术是一种创伤小、恢复快 ,治疗腹主动脉瘤安全有效的新方法 ,但远期疗效还有待进行继续随访。Objective To evaluate the preliminary clinical results of the endovascular procedures for management of the vascular diseases in a retrospective study.Methods Between February 1998 and February 1999,9 patients with 6 infrarenal abdominal aortic aneurysms,1 left common iliac arteriovenous fistula ,1 left subclavicular artery aneurysm and 1 severe stenosis in left common iliac artery were enrolled in Shanghai Zhongshan Hospital.Duplex,PVL and angiography were performed in each patient preoperatively.Computed tomography was performed in 6 patients with AAA and MRI in 1 case with severe stenosis in left common iliac artery preoperatively.The endovascular procedures were performed in all patients.Results The postoperative angiography showed all aneurysms and arteriovenous fistula were excluded by endografts,no endoleaks in the proximal or distal connections were detected and the stenosis disappeared .One patient died of renal failure 72 hours after the procedure because of the prolonged operative time and excessive contrast medium.Clinical success at 30 days was 88 88%.In the 12-month follow-up of 9 cases,no migration ,large endoleak and increasing aneurysm size were detected with SCT or Duplex.There was a small proximal endoleak in 1 case with subclavicular artery aneurysm and sealed spontaneously after 2 months.Conclusion Based on initial results and a limited mean follow-up period of 12 months,the endovascular treatment of the vascular diseases with stent-graft system is more feasible and safer.Further study will be required to observe their long-term success in the management of vascular diseases.

关 键 词：腹主动脉瘤 腔内人造血管 支撑术 血管外科 

分 类 号：R732.210.5[医药卫生—肿瘤] R730.56[医药卫生—临床医学]