腹主动脉瘤腔内治疗并发症内漏的诊治  

Diagnosis and management of endoleak after endovascular repair of abdominal aortic aneurysm

作　　者：郭伟[1] 刘小平[1] 孔庆龙[1] 李荣[1] 盖鲁粤[2] 梁法启[1] 张国华[1] 

机构地区：[1]解放军总医院普通外科,北京100853 [2]解放军总医院普通心内科,北京100853

出　　处：《中华外科杂志》2001年第8期586-589,共4页Chinese Journal of Surgery

基　　金：九五军队医药卫生科研资金资助 (97Z0 60 )

摘　　要：目的　探讨血管腔内技术治疗腹主动脉瘤时特有并发症内漏的诊断与处理方法。方法对已施行腔内治疗的 37例腹主动脉瘤患者进行回顾性分析 ,讨论部分患者并发内漏的原因、诊断、处理、结果及预后。　结果　 37例支架型血管放置完成后 ,13例发现存在不同程度的内漏 ,其中Ⅰ型 6例 ,Ⅱ型 3例 ,Ⅲ型 2例 ,Ⅳ型 1例 ,不明原因 1例。一期经相关技术处理后Ⅰ型、Ⅲ型内漏完全消失。手术结束时原发性内漏发生率 13 5 % (5 / 37)。随诊发现原发性内漏 3例自愈 ,2例转化为持续性内漏 ;另发现 2例继发性内漏。本组患者晚期内漏发生率 10 8% (4 / 37)。　结论　引起漏血的原因可能与瘤颈形态、长度、成角、钙化、移植物选择、分支血管血液倒流等因素有关。强调术中发现并一期处理 ,术后应密切随访。增强CT、血管超声和MRA检查是术后检测内漏的主要手段。Objective To determine the diagnosis and management of endoleak after endovascular repair of abdominal aortic aneurysm (AAA). Methods We analysed retrospectively the data of 37 cases of infrarenal AAA treated by endovascular repair and investigated the reasons, managements, results and prognosis of endoleaks. Results Of 13 patients with endoleak at stent graft deployment, 6 developed type Ⅰ endoleak, 3 type Ⅱ endoleak, 2 type Ⅲ endoleak, 1 type Ⅳ endoleak, and 1 unknow reason. Type Ⅰand Ⅲ endoleaks disappeared after mauagement with additional techniques.The primary endoleak rate was 13 5%(5/37). Three sealed endoleak, 2 persistent endoleaks and 2 secondary endoleaks were found during follow up. The late endoleak rate was 10 8% (4/37). Conclusions Endoleak is a chief complication after endovascular repair of infrarenal AAA. The influencing factors for endoleak include neck morphology,distance,angulation, calcification, stent graft selection and side branching arteries. Additional procedure and follow up are very important. Techniques to find endoleak include CTA, Duplex and MRA after operation. Endoleak with enlarged aneurysm should be treated actively.

关 键 词：腹主动脉瘤 手术后并发症 人工血管 腔内治疗 内漏 

分 类 号：R654.3[医药卫生—外科学]