腹主动脉瘤腔内治疗术后Ⅱ型内漏的单中心处理经验  

Single-center management experience of type Ⅱ endoleak after abdominal aortic aneurysm

作　　者：孙岩 王玉涛 吴学君 张十一 Sun Yan;Wang Yutao;Wu Xuejun;Zhang Shiyi(Department of vascular surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan Shandong Province 250021,China;Department of peripheral vascular disease,Jinan Municipal Hospital of Traditional Chinese Medicine,Jinan Shandong Province 250012,China)

机构地区：[1]山东第一医科大学附属省立医院血管外科,山东济南250021 [2]济南市中医医院周围血管病科,山东济南250012

出　　处：《中华普外科手术学杂志（电子版）》2022年第1期67-71,共5页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：山东省医药卫生科技发展计划项目(2018WS478);山东省医药卫生科技发展计划项目(2018WS273);济南市第二届优秀卫生计生人才培养项目(济卫科外发[2018]8号);济南市第三批“薪火传承231工程”培养项目(济中医药发[2017]11号);济南市卫生健康系统青年岗位能手培养项目(济卫发[2019]1号)。

摘　　要：目的探讨腹主动脉瘤腔内修复(EVAR)术后Ⅱ型内漏的处理。方法回顾性分析2011年1月至2019年1月12例EVAR术后Ⅱ型内漏行外科干预患者的临床资料。7例经肠系膜上动脉-中结肠动脉-Riolan弓-左结肠动脉-肠系膜下动脉途径,栓塞动脉瘤腔及肠系膜下动脉起始部。2例经股动脉-骼内动脉-骼腰动脉途径,栓塞动脉瘤腔及腰动脉起始部。2例经近远端移植物与动脉壁之间进入瘤腔应用弹簧圈栓塞瘤腔;1例行开腹剖开瘤体,瘤腔内缝扎腰动脉及肠系膜下动脉后,保留支架。结果患者均手术成功,无手术死亡及并发症。出院后平均随访(7.2±1.1)个月,1例患者因心脑血管意外死亡,其余患者无腰腹疼,影像学复查提示有4例行动脉栓塞患者再次复发,入院二次行栓塞治疗。结论Ⅱ型内漏在腹主动脉瘤腔内修复术后比较常见,通畅的肠系膜下动脉、多支腰动脉和动脉瘤腔内血栓体积较小是II型内漏发生的高危因素。对造成瘤体持续显著增长者可积极干预,治疗性干预有复发的可能性,预防性干预可能带来不必要的风险需要更严格的选择患者。Objective To investigate the management of type Ⅱ internal leakage endoleak after endovascular abdominal aortic aneurysm repair.Methods The clinical data of 12 patients with type Ⅱ endoleak after EVAR treatment from January 2011 to January 2019 were retrospectively analyzed.Seven cases had superior mesenteric artery-middle colonic artery-Riolan arch-left colon artery-inferior mesenteric artery,embolized the aneurysm cavity and the inferior mesenteric artery.Two cases passed the femoral artery-internal iliac artery-iliac lumbar artery,and embolized the aneurysm cavity and lumbar artery.Two cases entered the aneurysm cavity between the proximal and distal grafts and the arterial wall and used a spring coil to occlude the aneurysm cavity.One case underwent open dissection of the abdominal aortic aneurysm,and the lumbar artery and inferior mesenteric artery were sutured in the aneurysm cavity before retaining the stent.Results All patients are successfully operated without death or complication.The average follow-up was(7.2±1.1)months after discharge.One patient died due to cardio-cerebral vascular accident,while the remaining patients had no back and abdominal pain.Imaging review revealed that 4 patients with arterial embolism recurred,and received embolization treatment after admission.Conclusion Type Ⅱ endoleak is common after endovascular abdominal aortic aneurysm repair.Unobstructed inferior mesenteric artery,multiple lumbar arteries,and small thrombus volume in the aneurysm cavity are high risk factors for type Ⅱ endoleak.Those who cause persistent and significant tumor growth can be actively intervened,therapeutic intervention has the possibility of recurrence,and preventive intervention may bring unnecessary risks,requiring stricter selection of patients.

关 键 词：主动脉瘤 腹 内漏 腔内修复术 

分 类 号：R654.3[医药卫生—外科学]