主动脉腔内修复术治疗复杂近端瘤颈肾下腹主动脉瘤的中期疗效  

Mid-term efficacy of endovascular aortic repair in the treatment of infrarenal abdominal aortic aneurysm with complex proximal neck

作　　者：马腾腾 戴向晨[1] 罗宇东[1] 冯舟[1] 范海伦[1] 朱杰昌[1] 胡凡果[1] 张益伟[1] Ma Tengteng;Dai Xiangchen;Luo Yudong;Feng Zhou;Fan Hailun;Zhu Jiechang;Hu Fanguo;Zhang Yiwei(Department of Vascular Surgery,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院血管外科,天津300052

出　　处：《中华血管外科杂志》2020年第4期238-242,共5页Chinese Journal of Vascular Surgery

基　　金：天津市科技支撑重点项目(16YFZCSY01080)。

摘　　要：目的评估主动脉腔内修复术(EVRA)治疗复杂近端瘤颈肾下腹主动脉瘤(AAA)的中期疗效。方法收集2013年6月至2016年6月于天津医科大学总医院血管外科行EVAR的175例肾下AAA患者的资料。根据瘤颈解剖情况将患者分为复杂组与非复杂组,回顾性分析两组术中器械释放成功率、手术成功率、围术期和随访期并发症发生率等指标。结果复杂组84例,非复杂组91例,两组在性别、年龄、合并疾病及破裂AAA比例方面比较,差异无统计学意义(P均>0.05)。复杂组与非复杂组在瘤颈长度、瘤体直径和远端解剖因素复杂性方面,差异均有统计学意义(P均<0.05)。复杂组行非常规EVAR的比例高于非复杂组,差异有统计学意义(19.0%比0%,P=0.001)。复杂组与非复杂组在器械释放成功率(98.8%比100%)和手术成功率(95.2%比100%)方面,差异均无统计学意义(P均>0.05)。复杂组与非复杂组在术中近端瘤颈相关并发症发生率(4.8%比0%)和围术期死亡率(0%比2.2%)方面,差异均无统计学意义(P均>0.05)。175例患者均获得随访,随访时间为(52±10.3)个月,1例患者随访2个月时死于心肌梗死。复杂组与非复杂组在新发近端瘤颈相关并发症发生率(3.6%比0%)和二次手术干预率方面(15.5%比9.9%),差异均无统计学意义(P均>0.05)。结论EVAR[包括烟囱技术腹主动脉瘤腔内修复术(chEVAR)、开窗腹主动脉瘤腔内修复术(fEVAR)]治疗解剖条件适宜的复杂近端瘤颈肾下AAA中期疗效良好。fEVAR是拓展短近端锚定区的良好方法,但在瘤颈扭曲、急诊瘤体破裂的情况下,chEVAR仍具有重要作用;对接技术可用于粗瘤颈AAA。Objective To evaluate the mid-term result of endovascular aortic repair(EVRA)for infrarenal abdominal aortic aneurysm(AAA)with complex proximal neck.Methods Data of 175 patients with infrarenal AAA who underwent EVAR were collected in Department of Vascular Surgery,Tianjin Medical University General Hospital from June 2013 to June 2016.According to the anatomy of proximal neck,patients were divided into complex group and non-complex group.Technique success rate,surgical success rate,and perioperative and follow-up complications rates of the two groups were retrospectively analyzed.Results There were 84 cases in the complex group and 91 cases in the non-complex group.No significant differences in age,gender,co-morbidity and proportion of ruptured AAA were found between two groups(all P>0.05).When compared with non-complex group,the complex group had shorter neck length,larger aneurysmal diameter and more complicated distal anatomic factors(all P<0.05).The proportion of untraditional EVAR in the complex group[19%(16/84),14 cases of the chimney EVAR(chEVAR),2 cases of the fenestrated EVAR(fEVAR)]was significantly higher than that of non-complex group(0%,P=0.001).There were no significant differences in the success rate of device release and surgical success rate in the complex group compared with the non-complex group(98%vs 100%and 95.2%vs 100%,all P>0.05,respectively).The proximal neck-related complications in complex group(3 cases of typeⅠa endoleak,1 case of conversion to open surgery)was no significant difference compared with non-complex group(4.8%vs 0%,P=0.051).There was no intraoperative death in both groups.No significant difference was found in perioperative mortality between non-complex group and complex group(2.2%vs 0%,P=0.498).No new proximal neck-related complications occurred in both groups during the perioperative period.All cases were followed up for(52±10.3)months,and one case died of myocardial infarction at two-month follow-up.There was no significant difference in new proximal neck-related com

关 键 词：腹主动脉瘤 腔内修复术 瘤颈 内漏 

分 类 号：R654.3[医药卫生—外科学]