腔内修复术治疗复杂瘤颈成角腹主动脉瘤的中期疗效分析  

Mid-term outcome analysis of endovascular repair for complex aneurysmal neck angled abdominal aortic aneurysms

作　　者：伊斯马伊力江·阿卜杜喀迪尔 阿布都克尤木·吾甫尔 吾甫尔·依马尔[2] 王护国[2] Yisimayilijiang·Abudukadier;Abudukeyoumu·Wufuer;Wufuer·Yimaer;Wang Huguo(Department of Vascular Thyroid Surgery,The first People`s Hospital of Kashgar,Kashgar 844000,China;Department of Vascular Thyroid Surgery,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆喀什地区第一人民医院血管外科,喀什844000 [2]新疆医科大学第一附属医院血管甲状腺外科,乌鲁木齐830011

出　　处：《中华血管外科杂志》2023年第3期285-290,共6页Chinese Journal of Vascular Surgery

基　　金：新疆维吾尔自治区自然科学基金项目(2021D01C325)。

摘　　要：目的探讨复杂瘤颈成角的腹主动脉瘤(AAA)行腔内修复术的中期疗效。方法回顾性分析新疆医科大学第一附属医院2019年1月至2022年1月收治的130例择期行血管腔内修复术(EVAR)治疗的肾下型AAA患者的临床资料,其中男性114例,女性16例。根据近端瘤颈是否属于复杂瘤颈成角将患者分为复杂成角组(59例)和非复杂成角组(71例)。收集两组围术期资料和随访结果,比较两组的瘤颈解剖条件、术中情况及术后随访结果。结果两组在性别和D-二聚体水平方面差异有统计学意义[χ^(2)=6.457,P=0.012;779(615,2110)ng/ml比531(309,905)ng/ml,Z=-2.948,P=0.003],其他一般资料差异无统计学意义。与非复杂成角组相比,复杂成角组瘤颈长度更短[(3.98±1.67)cm比(3.38±1.72)cm,t=2.029,P=0.045],肾上角[(21.97±9.69)°比(40.30±19.27)°,t=6.645,P<0.001]和肾下角[(40.85±12.61)°比(70.92±11.58)°,t=14.048,P<0.001]的角度更大,瘤体直径[(4.62±0.93)cm比(5.76±1.50)cm,t=5.046,P<0.001]也更大,瘤颈血栓化程度更高(χ^(2)=4.093,P=0.043),差异均有统计学意义。130例患者EVAR手术均获得技术成功(100%)。130例患者均获得随访,随访时间为(13.43±7.69)个月。随访期间,死亡6例,其中复杂成角组和非复杂成角组各3例,均为非动脉瘤相关原因死亡。Ⅰ型内漏7例,其中复杂成角组5例,非复杂成角组2例;Ⅱ型内漏3例,其中复杂成角组2例,非复杂成角组1例;髂支内闭塞4例,复杂成角组和非复杂成角组各2例。两组患者在Ⅰ型内漏、Ⅱ型内漏、Ⅲ型内漏、夹层、髂支内闭塞、再次手术干预、死亡等并发症发生率比较,差异均无有统计学意义(均P>0.05);但复杂成角组总体并发症发生率高于非复杂成角组,差异具有统计学意义(27.1%比12.7%,χ^(2)=4.327,P=0.038)。结论腔内治疗复杂成角的肾下AAA有效、可行,中期疗效较好。Objective To investigate the mid-term outcome of endovascular repair for abdominal aortic aneurysm(AAA)with complex aneurysm neck angulation.Methods Data from 130 patients with subrenal AAA who were treated with elective endovascular aneurysm repair(EVAR)in The First Affiliated Hospital of Xinjiang Medical University from January 2019 to January 2022 were retrospectively analyzed,with 114 males and 16 females.The patients were divided into complex angulation group(n=59)and non-complex angulation group(n=71)according to whether the proximal aneurysmal neck was a complex aneurysmal neck angulation or not.The study collected perioperative data and follow-up results to compare the two groups'anatomical conditions of the aneurysmal neck,intraoperative conditions,and postoperative follow-up.Results There were statistically significant differences in gender(χ^(2)=6.457,P=0.012)and D-2 polymer levels[779(615,2110)ng/ml vs 531(309,905)ng/ml,Z=-2.948,P=0.003]between the two groups,and there was no statistically significant difference in other general data.Compared with the non-complex angulation group,the length of the aneurysmal neck in the complex angulation group was shorter[(3.98±1.67)cm vs(3.38±1.72)cm,t=2.029,P=0.045],the angles of the superior angle[(21.97±9.69)°vs(40.30±19.27)°,t=6.645,P<0.001]and inferior angle[(40.85±12.61)°vs(70.92±11.58)°,t=14.048,P<0.001]were larger,the aneurysm diameter was wider[(4.62±0.93)cm vs(5.76±1.50)cm,t=5.046,P<0.001],and the proportion of mural thrombus was higher(χ^(2)=4.093,P=0.043),with statistically significant differences.The EVAR procedure was technically successful in all 130 patients(100%).Follow-up was obtained in 130 patients for(13.43±7.69)months.During the follow-up period,6 cases died,including 3 cases each in the two groups,all of which died of non-aneurysm-related causes.Seven cases had intermediate type I endoleaks,including 5 in the complex angulation group and 2 in the non-complex angulation group.Three cases had intermediate type II endoleaks,includi

关 键 词：腹主动脉瘤 腔内修复治疗 瘤颈成角 预后 

分 类 号：R654.3[医药卫生—外科学]