烟囱技术在腹主动脉瘤腔内修复术中应用的中长期结果  

Mid- to long-term results of chimney -endovascular aortic repair for abdominal aortic aneurysm: single center result

作　　者：李文睿 李清乐[1] 张小明[1] 张韬[1] 李伟[1] 张学民[1] 焦洋[1] 蒋京军[1] Li Wenrui;Li Qingle;Zhang Xiaoming;Zhang Tao;Li Wei;Zhang Xuemin;Jiao Yang;Jiang Jingjun(Department of Vascular Surgery,Peking University People's Hospital, Beijing 100044 ,China)

机构地区：[1]北京大学人民医院血管外科,北京100044

出　　处：《中华普通外科杂志》2019年第3期222-224,共3页Chinese Journal of General Surgery

摘　　要：目的探讨烟囱技术腹主动脉瘤腔内修复术(chimney-endovascular aneurysm repair,Ch-EVAR)应用的中长期结果。方法回顾性分析北京大学人民医院2011年1月至2016年12月采用烟囱支架技术行EVAR手术患者的临床资料。结果本组21例患者中男18例,女3例,年龄平均74.0±6.31岁(62-83岁)。1例围手术期死亡,20例患者中位随访时间54.2个月。21例患者中1例行双侧肾动脉烟囱支架,14例行左侧烟囱支架置入,6例行右侧烟囱支架置入。技术成功率100%;术前血清肌酐与术后1周比较差异无统计学意义(P=0.639),术前估测肾小球滤过率与术后1周比较差异无统计学意义(P=0.804);术前、术后动脉瘤直径分别为(60.1±13.1)mm和(59.2±13.5)mm,差异无统计学意义(P=0.826)。随访期间5例患者死亡,无主动脉相关事件;发现1例U型内漏保守观察;烟囱支架通畅率100%。结论对于高手术风险的不良瘤颈腹主动脉瘤患者,腔内修复手术联合烟囱技术是安全和有效的选择。Objective To evaluate the mid- and long-term results of chimney-endovascular aneurysm repair ( Ch-EVAR) on efficacy and durability. Methods Data of abdominal aortic aneurysm (AAA) patients receiving Ch-EVAR were retrospectively collected and analyzed. Results From Jan 2011 to Dec 2016, 21 patients received Ch-EVAR in our institution including 18 males and 3 females with the average age 74. 0 ± 6. 31 years . One patient died and 20 patients were followed up for an mean period of 53. 2 months . During EVAR procedures 14 patients received left renal artery chimney stents, 6 patients had right renal artery chimney stents and one did bilateral renal artery chimney stents. Technical success was achieved in all patients ( 100%). Differences between preoperative and one-week postoperative value of serum creatinine ( P = 0. 639 ) and estimated glomerular filtration rate ( eGFR )( P =0. 804 ) showed no statistical difference. The differences of maximum sac diameter between preoperiation (60. 1 ± 13. 1 mm) and follow-up (59. 2 ± 13. 5 mm) was not significant (P = 0. 826). Six patients died during follow-up and none was aortic events related. All chimney stents were patent. One patient developed late type H endoleak and refused reintervention regardless of aneurysm expansion. Conclusion For short hostile neck AAA patients with considerable surgical risk Ch-EVAR may be an effective and durable alternative.

关 键 词：主动脉瘤 腹 血管成形术 烟囱技术 

分 类 号：R654.3[医药卫生—外科学]