开窗技术结合分支支架缝合技术在治疗髂动脉瘤中的探讨  

Application of fenestration combined with branch stent suture in the treatment of iliac aneurysms

作　　者：薛清泉 冯家烜 胡骥琼 冯桂林 XUE Qingquan;FENG Jiaxuan;HU Jiqiong;FENG Guilin(Department of Vascular Surgery,the First Affiliated Hospital of Wannan Medical College,Wuhu 241001,China;不详)

机构地区：[1]皖南医学院第一附属医院血管外科,芜湖241001 [2]海军军医大学第一附属医院血管外科

出　　处：《中国临床保健杂志》2024年第3期309-313,共5页Chinese Journal of Clinical Healthcare

基　　金：皖南医学院第一附属医院重点三新项目(Z21002)。

摘　　要：目的探讨在数字减影血管造影(DSA)下运用开窗技术结合分支支架缝合技术治疗髂动脉瘤的效果。方法回顾性分析2018年1月至2022年6月皖南医学院第一附属医院与海军军医大学第一附属医院血管外科收治的22例髂动脉瘤患者病历资料,采用腔内治疗的方法,对使用的覆膜支架进行体外开窗,并在开窗处缝制分支支架,在隔绝髂动脉瘤的同时保留了髂内动脉。结果1例右侧髂动脉瘤破裂患者在进行腔内治疗的过程中,生命体征不平稳,术中改变手术方式,栓塞髂内动脉后覆膜支架隔绝髂动脉瘤治疗;1例右侧髂动脉瘤患者因瘤体严重扭曲且狭窄,导致开窗位置无法对准髂内动脉开口,术中改变手术方式,使用弹簧圈直接栓塞髂内动脉;余20例患者均手术成功,在完全隔绝髂动脉瘤的基础上,充分保留了同侧的髂内动脉。结论开窗技术结合分支支架缝合技术能在有效隔绝髂动脉瘤的同时,保留髂内动脉的血液供应,对于避免臀肌缺血、肠管缺血及保护男性性功能有着重要意义;其手术方式较传统开放手术创伤性更小,更安全。Objective To explore the application of window opening technique combined with branch stent suture technique in the treatment of iliac artery aneurysm under digital subtraction angiography(DSA).Methods A retrospective analysis was conducted in 22 patients with iliac artery aneurysms admitted to department of vascular surgery of the First Affiliated Hospital of Wannan Medical College and the First Affiliated Hospital of the Chinese People′s Liberation Army Naval Medical University from January 2018 to June 2022.Intraluminal treatment was used to perform an external window opening on the covered stent,and a branch stent was sewn at the window opening to isolate the iliac artery aneurysm while preserving the internal iliac artery.Results One patient with a ruptured right iliac artery aneurysm had unstable vital signs during endovascular treatment.The surgical method was changed during the operation,and the iliac artery was occluded and covered with a stent to isolate the aneurysm.A patient with a right iliac artery aneurysm was severely twisted and narrowed,causing the window position to be unable to align with the opening of the internal iliac artery.During the surgery,the surgical method was changed and a spring coil was used to directly embolize the internal iliac artery.The remaining 20 patients underwent successful surgery,fully preserving the ipsilateral internal iliac artery while completely isolating the iliac artery aneurysm.Conclusions The combination of fenestration technique and branch stent suture technique can effectively isolate iliac artery aneurysm while preserving the blood supply of the internal iliac artery,which is of great significance for avoiding gluteal muscle ischemia,intestinal ischemia,and protecting male sexual function with better safety,less trauma and faster recovery.

关 键 词：髂动脉瘤 开窗技术 分支支架缝合技术 腔内治疗 

分 类 号：R654.4[医药卫生—外科学]