双球囊封堵联合瘤腔内纤维蛋白黏合剂注射技术在破裂腹主动脉瘤腔内修复术中的应用  

Endovascular repair of ruptured abdominal aortic aneurysms assisted by double balloon occlusion technique combined with intra-aneurysm fibrin binder injection technique

作　　者：魏立春[1] 苏奕明 许太福 郑志勇[1] 张科[1] 罗长志[1] 郑毅[1] 韦肖敏 叶奕辉[1] 蓝宇俭 王有福 侯培勇[1] Wei Lichun;Su Yiming;Xu Taifu;Zheng Zhiyong;Zhang Ke;Luo Changzhi;Zheng Yi;Wei Xiaomin;Ye Yihui;Lan Yujian;Wang Youfu;Hou Peiyong(Department of Vascular Surgery,the Fourth Affiliated Hospital of Guangxi Medical University,Liuzhou 545005,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西医科大学第四附属医院血管外科,广西壮族自治区柳州市545005

出　　处：《中华外科杂志》2021年第12期987-993,共7页Chinese Journal of Surgery

基　　金：柳州市科技计划项目(2018BJ10508)。

摘　　要：目的探讨双球囊交替封堵联合瘤腔内人纤维蛋白黏合剂注射技术在破裂腹主动脉瘤(rAAA)腔内修复术中的应用效果。方法回顾性分析广西医科大学第四附属医院血管外科2015年1月至2019年12月收治的28例rAAA患者的临床资料。男性23例,女性5例,年龄(62±5)岁(范围:46~88岁)。瘤体最大径(65.2±10.5)mm(范围:47.3~100.5 mm),均为肾下型rAAA。患者均在急救绿色通道流程下应用肾下和肾上主动脉双球囊交替封堵联合瘤腔内人纤维蛋白黏合剂注射技术成功完成腹主动脉瘤腔内修复术(EVAR)。收集患者术前准备时间、手术时间、住院时间、手术救治成功率、术后并发症发生率,以及随访期间主动脉支架形态、内漏发生率、分支支架通畅率及支架感染率。结果28例患者术前准备时间(45.5±8.5)min(范围:20~100 min),手术时间(100.0±15.5)min(范围:85~210 min),ICU停留时间(7±2)d(范围:1~17 d),住院时间(13.5±2.5)d(范围:5~43 d)。手术救治成功率为92.9%(26/28);死亡2例,1例死于术后多灶性腔隙性脑梗塞并发消化道大出血,1例高龄(84岁)患者因术前腹主动脉瘤破裂出现大量腹水,术后并发腹腔间隔室综合征,继发多器官功能衰竭死亡。术中肾上主动脉球囊阻断时间(13±2)min(范围:12~30 min)。22例术中瘤腔内注射纤维蛋白黏合剂(14±2)ml(范围:6~28 ml)。术后主要并发症发生率为57.1%(16/28)。26例存活患者术后随访(30±3)个月(范围:13~48个月),3年随访率为69.2%(18/26),随访期间患者主动脉支架均在位良好,无明显移位。术后6个月内漏发生率为11.5(3/26);术后36个月18例患者均无内漏发生,肾动脉、髂动脉分支支架通畅率为88.9%(16/18);术后支架感染率为7.7%(2/26),分别为术后1个月和6个月各1例,予长时间强化抗感染治疗后均康复。结论在规范急救流程下,rAAA患者在EVAR术中采用双球囊交替封堵配合术中瘤腔内纤维蛋白黏合剂注射的手术成功�Objective To investigate the long-term efficacy and safety of alternating double balloon occlusion combined with intra-aneurysm injection of human fibrin binder in the endovascular repair of ruptured abdominal aortic aneurysm(rAAA).Methods The clinical data of 28 patients with rAAA admitted to Department of Vascular Surgery,the Fourth Affiliated Hospital of Guangxi Medical University from January 2015 to December 2019 were retrospectively analyzed.There were 23 males and 5 females,aged(62±5)years(range:46 to 88 years).The maximum diameter of the tumors was(65.2±10.5)mm(range:47.3 to 100.5 mm),all of which were subrenal rAAA.The intraoperative EVAR for abdominal aortic aneurysm was successfully performed under the emergency green channel procedure,and this surgery was assisted used the double balloon occlusion technique in aorta of inferior renal and superior renalcombined with intraoperative human fibrin binder injection technique.Observation indexes included:patients with preoperative preparation,operation time,hospitalization days,surgical treatment success rate and the incidence of postoperative complications,and aortic stent form during the follow-up period,the incidence of leakage,branch stents patency rate and infection rates.Results The preoperative preparation time of 28 patients was(45.5±8.5)minutes(range:20 to 100 minutes).The operation time was(100.0±15.5)minutes(range:85 to 210 minutes),the ICU stay time was(7±2)days(range:1 to 17 days).The length of hospitalization was(13.5±2.5)days(range:5 to 43 days).The success rate of surgical treatment was 92.9%(26/28).Two patients died,1 case died of postoperative multifocal lacunar cerebral infarction and massive gastrointestinal hemorrhage,and another elderly patient(84 years old)died of massive abdominal fluid due to preoperative abdominal aortic aneurysm rupture,postoperative complicated with significant abdominal compartment syndrome,and secondary multiple organ failure.Balloon occlusion of the upper renal aorta took(13±2)minutes(range:12 to 30 minu

关 键 词：主动脉瘤 腹 动脉瘤 破裂 双球囊 纤维蛋白黏合剂 腔内修复术 

分 类 号：R654.3[医药卫生—外科学]