复合支架方案在复杂肾下腹主动脉瘤腔内治疗中的应用及疗效观察  

Application and effect observation of hybrid aortic stent grafts for endovascular repair in the treatment of complicated infrarenal abdominal aortic aneurysm

作　　者：于晓强[1] 岳嘉宁[2] 董智慧[2] 刘燕[1] 陆晨希[1] 仲崇俊[1] 符伟国[2] 

机构地区：[1]南通大学第二附属医院心血管外科,江苏南通226001 [2]上海复旦大学附属中山医院血管外科复旦大学血管外科研究所

出　　处：《中华医学杂志》2016年第18期1430-1434,共5页National Medical Journal of China

基　　金：江苏省卫生厅科研项目（Z201223）

摘　　要：目的评价复合支架方案对复杂肾下腹主动脉瘤患者行腔内隔绝手术（EVAR）的有效性。方法回顾性分析2010至2015年问复旦大学附属中山医院138例接受EVAR手术的复杂肾下腹主动脉瘤患者的临床资料。根据使用支架情况将患者分为复合支架组（28例）和标准支架组（110例）；前者定义为使用1种以上的品牌支架组合完成EVAR手术，后者定义为仅使用1种品牌支架完成EVAR手术。所有患者于术后1、3、6、12个月接受随访，复查胸腹主动脉CT血管造影。比较2组患者术后住院天数、内漏发生率、术后支架内血栓形成率、入路并发症发生率、系统并发症发生率、中转开放手术发生率、二次干预率等指标的差异。结果复合支架组和标准支架组患者均获得技术成功，术后30d均无死亡，无瘤体破裂。复合支架组和标准支架组患者术后住院天数分别为（5．35±2．99）d和（5．92±3．70）d，差异无统计学意义（t=0．753，P〉0．05）。2组患者内漏发生率分别为10．7％和18．2％，术后支架内血栓形成率分别为3．6％和10．9％，入路并发症发生率分别为0和1．8％，系统并发症发生率分别为7．1％和0．9％，中转开放手术发生率分别为0和0．9％，差异均无统计学意义（x^2=0．896、1．408、0．517、4．078、0．256，均P〉0．05）。但2组患者术后二次干预率分别为3．6％和19．1％，差异有统计学意义（X。=4．011，P〈0．05）。结论使用复合支架对近端瘤颈以及髂动脉解剖困难的复杂肾下腹主动脉瘤患者实施EVAR手术，可以降低术后二次干预率。Objective To evaluate the effectiveness of the hybrid graft technique for complicated infrarenal abdominal aortic aneurysms （AAAs）. Methods The clinical data of 183 patients who underwent endovascular aneurysm repair （EVAR） for AAA with challenging anatomy at Zhongshan Hospital Affiliated to Shanghai Fudan University from 2010 to 2015 were retrospectively analyzed. Endografts were divided into two groups： Hybrid Group （28 cases） used more than one type of stent graft, and Standard Group （110 cases） used only one stent graft type. Patients were recommended to undergo CT angiography at 1,3,6,12 month after the procedure. Clinical data were analyzed with a focus on postoperative hospital stay, endoleak, limb occlusion, complications of approach, complications of system, converted to open operation and secondary intervention. Results Technical success was achieved in all patients in both groups. Compared with hybrid group and standard group, there was no difference in postoperative hospital stay （ （5.35 ± 2.99） and （5.92 ± 3.70） days, t = 0. 753, P 〉 0.05 ）. During the follow up, there was no difference in endoleak （ 10.7% and 18.2% ）, limb graft occlusion （ 3.6% and 10.9% ）, complications of approach （0 and 1.8% ）, complications of system （7.1% and 0.9% ）, converted to open operation （0 and 0.9% ） between two groups （x^2 = 0. 896, 1. 408, 0. 517, 4. 078, 0. 256, all P 〉 0. 05）. However, there was statistically significant difference in secondary intervention between two groups （3.6% and 19.1% , 2 = 4.011, P 〈 0.05 ）. Conclusion The use of hybrid stent graft in patients with unfavorable neck and iliac artery anatomy AAA is feasible, and it could improve the postoperative outcomes such as secondary intervention rate.

关 键 词：主动脉瘤 腹 支架 腔内隔绝术 疗效比较研究 

分 类 号：R654.3[医药卫生—外科学]