＂解剖固定＂概念在腹主动脉瘤腔内修复术患者中的临床应用  

Clinical application of ＂ Anatomical fixation＂ in the endovascular repair of abdominal aortic aneurysm

作　　者：柏骏[1] 曲乐丰[1] 职康康[1] 高志伟[1] 吴永发[1] 徐良[1] 

机构地区：[1]第二军医大学长征医院血管外科,上海200003

出　　处：《中华医学杂志》2014年第1期6-9,共4页National Medical Journal of China

基　　金：“东方学者”特聘教授培养计划;上海市浦江人才培养计划（A类）（08PJ1400300）

摘　　要：目的总结“解剖固定”在腹主动脉瘤腔内修复术中的应用并探讨其中远期疗效。方法回顾分析自2008年1月至2013年1月间，上海长海医院血管外科和长征医院血管外科运用“解剖固定”方法完成的125例腹主动脉瘤腔内修复术的病例资料及术后随访结果。结果技术成功率100％，术中发生Ⅰ型内漏3例（2．4％），发生Ⅱ型内漏4例（3．2％），I型内漏发生率困难瘤颈病例高于非困难瘤颈病例，差异有统计学意义（P〈0．001）。剔除1例围手术期死亡病例，对124例成功病例平均（26．4±1．5）个月随访（1～60个月）。无动脉瘤及支架移植物破裂，无支架移植物远端移位。新发生Ⅰ型内漏2例（1．6％），2例新发Ⅱ型内漏（1．6％）。左下肢动脉栓塞1例（0．8％），二次手术干预1例（0．8％）。死亡病例3例（2．4％），2例死亡原因为急性心肌梗死，1例为对比剂肾病，肾功能衰竭。结论“解剖固定”在腹主动脉瘤腔内修复术中的应用，丰富了腹主动脉瘤腔内修复术的治疗理论，有效防止了腹主动脉瘤腔内修复术后支架移植物移位，提高了困难瘤颈病例修复率，降低手术并发症率。Objective This paper aims to evaluate the clinical applyment of ＂Anatomical fixation＂ and its long-term efficacy . Methods Retrospective analysis of elinieal data and postoperative follow-up results of 125 patients undogoing EVAR using ＂anatomical fixation＂ enrolled in Shanghai Changhai hospital and Shanghai Changzheng hospital from January 2008 to January 2013. Results The technical success rate waslO0%, Perioperative complications including Type I endoleak occurred in 3 patients （2.4%）, 4 cases of type Ⅱ endoleak （3.2%）. Incidence of Type I endoleak in challenging neck cases was high than non- challenging neck cases, the difference was statistically significant （ P 〈 0. 001 ）. After 30 days and through current follow-up of 124 successful cases（ mean：26.4 ± 1.5 months,rangel -60 months）. No rupture of the aneurysm and stent graft migrations occurred. Secondary type Ⅰ endoleak in 2 cases （ 1.6% ） ,Two cases of secondary type 11 endoleak （ 1.6% ）. Left lower extremity arterial thrombosis in 1 case （ 0. 8% ）, and secondary surgical intervention in 1 case （0. 8% ）. Three cases of deaths in cumulative, 2 patients died died of acute myocardial infarction. At 3 months, a patient died of the contrast-induced nephropathy, renal failure. Conclusions The clinical applyment of ＂Anatomical fixation＂ enriched the theory of EVAR, completely solved the complication of incidence of stent-graft migration, greatly improve the repair rate of hostile neck cases, expand the indications for EVAR

关 键 词：腹主动脉瘤 腔内治疗 解剖固定 支架移植物移位 

分 类 号：R654.3[医药卫生—外科学]