经皮主动脉腔内修复术中不同缝合技术应用的比较  

Comparison of different closure techniques in percutaneous endovascular aortic repair

作　　者：赖浚兴[1] 谭文峰[1] 彭宇程[1] 

机构地区：[1]江门市中心医院心内科,广东江门529071

出　　处：《岭南心血管病杂志》2016年第2期177-180,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的比较血管缝合器(vascular closure device,VCD)预埋技术与传统股动脉切开缝合技术在经皮主动脉腔内修复术(endovascular aortic repair,EVAR)中的应用。方法将86例行EVAR的主动脉瘤或主动脉夹层患者随机分成两组:试验组采用VCD(VCD采用Perclose Proglide^(TM),美国雅培)预埋技术(54例)、对照组采用传统股动脉切开后缝合技术(32例)。观察两组患者术后卧床时间、住院时间,术口部位有无出血、血肿、足背动脉搏动情况、术后30 d复查电子计算机断层扫描血管造影(CTA)或彩色多普勒超声检查了解吻合口有无血管并发症等。结果 86例患者EVAR手术成功。试验组共采用132枚VCD修复69条股动脉,其中9条股动脉使用3枚VCD,1条股动脉缝合失败(24 F),1例术后6个月出现右股动脉局限严重狭窄,均行外科处理痊愈,缝合成功率为98.5%(68/69)。对照组32例手术成功,处理40条股动脉,术后大血肿并重新切开处理1例,术后1个月随访均未见明显狭窄。试验组与对照组在手术时间[(2.4±1.5)h vs.(3.2±0.9)h]、卧床时间[(1.8±0.9)d vs.(8.6±4.7)d],术后住院时间[(4.6±1.8)d vs.(12.5±5.1)d]等方面存在明显差异(P<0.05)。结论采用VCD预埋技术完成EVAR安全可行,尤其在缩短卧床及住院时间方面显示出明显的优势。Objectives To assess the advantages and disadvantages of preclose technique with vascular closure device （VCD） and femoral artery suture after incision in percutaneous endovascular aortic repair （EVAR）. Methods Totally 86 cases with aortic aneurysm or aortic dissection were randomly divided into two groups： 54 cases as VCD （Perclose ProglideTM, Abbott, USA）group and 32 cases as control group with femoral artery suture after incision in EVAR. Duration of bed rest after operation, duration of stay, occurrence of bleeding, hematoma and dorsalis artery pulse, vascular complications observed by computed tomographical angiography （CTA） or color Doppler ultrasound 30 days after operation were compared. Results All the EVAR operations succeeded. VCD group used 132 VCDs in 69 femoral arteries, among which 9 femoral arteries used 3 VCDs, 1 case failed in closure （24F） and 1 case was found serious femoral artery stenosis 6 months after operation. They all received surgical operation and recoverd. The success rate was 98.5% （68/69）. Forty femoral arteries were managed in control group, among which 1 case with large hematoma was reincised and no obvious stenosis was found during the 1 month follow-up. Two groups had obvious differences （P〈 0.05） in operation duration [ （2.4±1.5） h vs. （3.2±0.9） hi, duration of bed rest after operation [ （1.8±0.9） d vs. （8.6±4.7） d] and duration of stay [（4.6±1.8） d vs. （12.5±5.1） d]. Conclusions The preclose technique with VCD for closure is safe and feasible, which is superior in shortening duration of bed rest and duration of stay after operation.

关 键 词：主动脉腔内修复术 血管缝合器 股动脉切开 预埋技术 

分 类 号：R654.3[医药卫生—外科学]