术中弹簧圈瘤腔栓塞应用于腹主动脉瘤腔内治疗术后Ⅱ型内漏高危人群的疗效及影响因素分析  

Intraoperative sac coiling embolization in type Ⅱ endoleak high-risk population after endovascular aortic repair

作　　者：李先涛[1] 黄燕燕 陈瑞权[2] 郭梅红 郭平凡[1] Li Xiantao;Huang Yany an;Chen Ruiquan;Guo Meihong;Guo Pingfan(Department of Vascular Surgery,the First Affiliated Hospital of Fujian Medical University,Fuzhou 3500 4,China;Department of Radiology,the First Affiliated Hospital of Fujian Medical University f Fuzhou 350004,China;Department of Statistics,Public Health School of Fujian Medical University,Fuzhou 350004,China)

机构地区：[1]福建医科大学附属第一医院血管外科,福州350004 [2]福建医科大学附属第一医院影像科,福州350004 [3]福建医科大学公共卫生学院卫生统计系,福州350004

出　　处：《中华普通外科杂志》2019年第9期745-749,共5页Chinese Journal of General Surgery

基　　金：福建省科技计划项目引导性项目(2018Y0028)。

摘　　要：目的探讨术中弹簧圈瘤腔栓塞在腹主动脉瘤腔内治疗术后Ⅱ型内漏高危人群中预防Ⅱ型内漏的有效性及影响因素。方法回顾性分析符合入选标准的Ⅱ型内漏高危患者共112例,其中术中弹簧圈瘤腔栓塞组36例(栓塞组),施行标准EVAR术76例(标准组),对两组的临床资料进行比较。结果栓塞组术中使用栓塞的弹簧圈数量平均(2.72±1.16)个(1~7个)。中位随访时间25.9个月,口型内漏发生率标准组为30.3%(23/76)高于栓塞组的11.1%(4/36)(x^2=4.90,P=0.027)。多因素分析发现Ⅱ型内漏的危险因素为无瘤腔栓塞和瘤腔体积≥128 cm^3。在大瘤腔亚组中,瘤腔栓塞组的Ⅱ型内漏发生率显著低于标准EVAR组(x^2=6.07,P=0.014)。结论术中弹簧圈瘤腔栓塞用于Ⅱ型内漏高危人群是安全有效的,其在大瘤腔中的应用能有效减少EVAR术后Ⅱ型内漏发生率。Objective To investigate the effectiveness and safety of intraoperative sac coiling embolization among patients who are athigh-risk developing type-Ⅱ endoleak after endovascular aortic repair(EVAR).Methods From Jan 2014 to Jan 2018,one hundred and twelve consecutive patients with infrarenal AAA were enrolled for this study,There were 76 patients undergoing standard EVAR(standard-group)and 36 patients doing aneurysmal sac coiling embolization(embo-group).Baseline characteristics,aneurysmal sac parameters,radiological intervention details and follow up results were recorded.Results Mean follow-up time was 25.9 m for embo-group.During follow-up period,no coils-related complications were noted and no type-Ⅱ endoleak associated secondary interventions were reported.A mean of(2.12±1.16)coils(range 1-7)was used in the embo-group.The incidence of type Ⅱ endoleak was 30.3%(23/76)in standard-group and 11.1%(4/36)in embo-group(x^2=4.90,P=0.027).Logistic multivariate analysis revealed that the independent risk factors of type Ⅱ endoleak after endovascular aortic repair for high-risk patients were those EVAR without sac embolization and sac volume 128 cm3.In the subgroup analysis(sac volume M128 cm^3),the incidence of type-Ⅱ endoleak was lower in embo-group compared to standard-group(x^2=6.07,P=0.014).Conclusion Intraoperative sac coiling embolization in high-risk patients is safe and effective in prevention of type Ⅱ endoleak.This preventive effect is more significant with large sac aneurysm compared to small sac aneurysm.

关 键 词：主动脉瘤 腹 放射学 介入性 内漏 危险性评估 

分 类 号：R65[医药卫生—外科学]