分叉型一体式覆膜支架在腹主动脉瘤腔内修复术中的应用  

Single-center experience on clinical application of ＆quot;anatomic fixation＆quot; unibody bifurcated stent-graft in endovascular repair

作　　者：柏骏[1] 曲乐丰[1] 职康康[1] 高志伟[1] 邹思力[1] 吴永发[1] 王亮[1] 金杰[1] 吴鉴今[1] 

机构地区：[1]第二军医大学附属长征医院血管外科,上海200003

出　　处：《中华医学杂志》2014年第19期1462-1465,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 总结分叉型一体式覆膜支架在腹主动脉瘤腔内修复术中的临床使用特点及效果.方法 回顾分析2008年1月至2013年1月间运用分叉型一体式覆膜支架腔内修复125例（上海长海医院血管外科102例,上海长征医院血管外科23例）腹主动脉瘤的病例资料和术后随访结果.结果 支架植入的技术成功率为100％,术中发生Ⅰ型内漏3例（2.4％）,术中发生Ⅱ型内漏4例（3.2％）,Ⅰ型内漏的发生率与瘤颈的形态相关,差异有统计学意义（P=0.001）.1例患者在围手术期死亡,对124例病例进行了平均（26.4±1.5）个月的随访（1～ 60个月）：无动脉瘤破裂;无支架移植物远端移位;新发生Ⅰ型内漏2例（1.6％）,新发生Ⅱ型内漏2例（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例为肾功能衰竭.结论 分叉型一体式的结构设计可避免术后支架移植物远端移位,且更适合瘤体及主动脉分叉处狭窄的患者.应用分叉型一体式覆膜支架腔内治疗腹主动脉瘤是安全、有效的.随访数据表明,中远期疗效可靠.Objective To evaluate the clinical outcomes of unibody bifurcated stent-graft in endovascular repair （EVAR）.Methods Retrospective analyses were conducted for the clinical data and postoperative follow-up results of 125 patients （102 cases from Shanghai Changhai Hospital and another 23 from Shanghai Changzheng Hospital）undergoing EVAR with unibody bifurcated stent-graft from January 2008 to January 2013.Results The technical success rate was 100%.Perioperative complications including type Ⅰ endoleak （n =3,2.4%） and type Ⅱ endoleak （n =4,3.2%）.The incidence of type Ⅰ endoleak in challenging neck cases was higher than non-challenging ones.And the difference was statistically significant （P =0.001）.Except for 1 dead case,the remainder was followed up for a mean of 26.4 ± 1.5 （1-60）months.Neither aneurysm rupture nor stent-graft migration occurred.Late type Ⅰ endoleak occurred （n =2,1.6%）.There were left lower extremity arterial thrombosis （n =1,0.8%） and surgical reintervention （n =1,0.8%）.Among 3 dead cases,2 died from acute myocardial infarction and another 1 contrastinduced nephropathy.Conclusion Unibody bifurcated stent-graft is both safe and efficacious in the treatment of abdominal aortic aneurysm without the risk of long-term migration.Moreover,it has excellent outcomes for hostile neck or narrow abdominal aortic bifurcation.

关 键 词：腹主动脉瘤 腔内修复术 一体式覆膜支架 解剖固定 支架远端移位 

分 类 号：R654.3[医药卫生—外科学]