影响腔内修复术治疗自身免疫病相关性主动脉假性动脉瘤远期预后的危险因素分析  

Risk factors for long-term result of endovascular treatment for auto-immune disease related abdominal aorta pseudo-aneurysm

作　　者：叶炜[1] 狄潇[1] 刘琦[1] 李拥军[1] 郑月宏[1] 曾嵘[1] 宋小军[1] 刘志丽[1] 刘昌伟[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院血管外科,100730

出　　处：《中华医学杂志》2016年第45期3637-3641,共5页National Medical Journal of China

摘　　要：目的 回顾性总结自身免疫病相关性主动脉假性动脉瘤（AIPA）腔内修复术的临床结果，分析影响治疗结果和预后的相关危险因素。方法 回顾性收集2000至2015年北京协和医院血管外科接受腔内修复术治疗的AIPA病例29例，其中男25例，女4例，年龄23～67岁，平均年龄（39.3±11.4）岁。分析患者主动脉假性动脉瘤病变与自身免疫病的相关性，主动脉腔内修复与围手术期免疫治疗结果，分析长期免疫治疗与随访结果的相关危险因素。结果 29例AIPA病例中，白塞病22例，大动脉炎4例，系统性红斑狼疮2例，结节性多动脉炎1例。其中假性动脉瘤破裂/先兆破裂8例，其余21例均为腹部隐痛或无明显症状。假性动脉瘤破口部位：24例为肾下腹主动脉，2例为肾旁和肾上腹主动脉，2例累及腹腔干动脉以上的腹主动脉，1例为胸腹主动脉多发假性动脉瘤。除急诊手术的3例外，其余26例均接受规律免疫治疗后再行腔内修复术。所有患者均于全麻下完成手术。治疗方式包括：单纯行覆膜支架植入19例，开窗支架植入5例，支架联合内脏动脉或外周动脉旁路复合手术5例，手术均获得成功，无中转开腹手术。围手术期发生伤口并发症3例，肺部感染3例。无围手术期死亡发生。全组术后随访1～120个月，共有5例出现假性动脉瘤复发，1例髂支血栓形成，再次外科干预5例。无内脏重建血管再闭塞发生。随访期内死亡3例，1例为动脉瘤相关性死亡，2例为其他原因死亡。对于术后发生严重临床不良事件（MACE）的常见危险因素进行单因素回归分析，发现患者在随访期内停药、年龄≥40岁与随访期内出现MACE有相关性（P〈0.05），而原发自身免疫病种类、非标准EVAR手术等因素与MACE无相关性。结论 腔内修复术治疗AIPA是安全有效的治疗方式，结合术前免疫活动的有效控制，围手术期的�Objective To summarize results of endovascular treatment for auto-immune disease related abdominal aorta pseudo-aneurysm（AIPA）, and to analysis clinical predictors of long term major adverse clinical events（MACE）.Methods Retrospectively collected endovascular treatment for AIPA cases in Peking Union Medical College Hospital within 2000 to 2015. Twenty-nine cases with AIPA treated by endovascular therapy were enrolled in this study. Twenty five cases were male, range from 23 to 67 years old, mean age was （39.3±11.4） years old.Demographic characters, locations of aneurysms, type to auto-immune disease, immuno medical therapy, operation strategy and long term follow-up data were reported. Statistical analysis was made to verify clinical predictors of long-term MACE.Results Among the 29 cases, 22 cases with bechet′s disease, 4 cases with Takayasu′s arteritis, 2 cases with systemic lupus erythematosus, 1 cases with polyarteritis nodosa. Eight cases had ruptured or pending ruptured pesudo-aneurysms, the rest 21 cases had dull pain or no overt symptome. Twenty-four cases had infra-renal artery aneurysms, two were para-and supra-renal artery, two were supra-celiac artery, and the rest one had multiple aneurysms involved thoracic and abdominal aorta.All the cases received regular immune medical therapy except the three emergency cases. All the operations were under general anaesthesia. Nineteen cases underwent classical Endovascular aortic aneurysm repair （EVAR）, 5 cases underwent fenestration EVAR, the rest 5 cases underwent hybrid procedure. All the 29 operations were successful, without conversion to open surgery. Major peri-operation complication included 3 incision infection, 3 pulmonary infection. No death occurred. All the cases received regular follow-up from 1 to 120 months. There were five recurrence of pseudo-aneurysm, 1 case suffered from iliac limb occlusion. 5 cases received re-intervention procedure. No occlusion of revascularizal visceral artery was found during follow-up. There were 3

关 键 词：动脉瘤 假性 血管成形术 支架 

分 类 号：R654.3[医药卫生—外科学]