腔内修复技术在高龄腹主动脉瘤治疗中的应用  

The application of EVAR in the treatment of octogenarian patients with abdominal aortic aneurysm

作　　者：周伟[1] 辛军[1] 周建平[1] 陆军[1] 杜巍[1] 李伟阳[1] 

机构地区：[1]东莞市人民医院心胸外科,广东省东莞523000

出　　处：《中国基层医药》2015年第22期3451-3454,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：探讨腔内修复技术（EVAR）在治疗高龄腹主动脉瘤患者中的应用效果。方法收集年龄≥80（87．0±6．2）岁腹主动脉瘤患者腔内修复手术16例，其中男性11例，急诊手术2例，均为肾下型腹主动脉瘤，动脉瘤解剖条件复杂11例，占69％，术后进行1月至3年随访，回顾性分析手术成功率、并发症情况，评价治疗效果，分析总结针对高龄腹主动脉瘤患者腔内治疗的特点及经验。结果16例患者均顺利完成手术，手术成功率达100％，术中使用主体覆膜支架 Medtronic Endurant 12枚及 Medtronic Talant 4枚，手术时间67～182 min，平均（92±25）min，术后3 d 因心衰死亡1例，术后出现并发症11例，占69％，随访期内因Ⅰ型内漏死亡1例，其他原因死亡4例。结论对于高龄腹主动脉瘤患者腔内治疗手术成功率高，是首选治疗方法，但需注意采用相应措施减少并发症的发生，手术中、远期疗效需根据患者具体情况进行个体化评估。Objective To analyze the effect of EVAR in the treatment of octogenarian patients with abdominal aortic aneurysm.Methods 16 octogenarian patients aged over 80 years who treated with EVAR were collected. Mean age was （87.0 ±6.2）years and included 11 cases in male,2 cases in emergency.All the cases were infrarenal abdominal aortic aneurysm and 11 cases （69%）were the complex aortic anatomy.According to ASA classification, 11 cases （69%）were class Ⅲ and 5 cases （31%）were class Ⅳ.All patients were followed up with CT for 1 month to 3 years.We evaluated technical success rate,perioperative complications and the application characteristics of EVAR in the treatment of octogenarian patients with abdominal aortic aneurysm were analyzed.Results All the patients were operated with EVAR,the success rate was 100%,12 Endurant endografts and 4 Talent endografts were used.Mean operation time was （92 ±25）min and mean hospital stay length was （17 ±9.5）days.1 patient died with heart failure in 3 days after operation.1 patient died due to the Ⅰ endoleak and 4 patients died due to other fators. Conclusion For the octogenarian abdominal aortic aneurysm patients,EVAR is the preferred treatment with acceptable procedural success and perioperative morbidity.Those patients have characteristics in the physiological function and anatomy,so we should take measures to prevent the complications.The medium and long -term results suggest that EVAR may be of limited in some patients who are aged over 80 years.

关 键 词：腹主动脉瘤 高龄 腔内修复治疗 微创 

分 类 号：R654.4[医药卫生—外科学]