烟囱支架技术治疗近肾腹主动脉瘤的疗效  

Efficacy of chimney graft technique in the endovascular treatment of pararenal aortic aneurysm

作　　者：余文水[1] 刘静 杨红伟[1] 韩同磊 鲍贤豪 王祖辉[1] 夏永娣[1] 朱国献[1] Yu Wenshui;Liu Jing;Yang Hongwei;Han Tonglei;Bao Xianhao;Wang Zuhui;Xia Yongdi;Zhu Guoxian(Department of Vascular Surgery,the Second People's Hospital of Shenzhen(the First Affiliated Hospital of Shenzhen University),Shenzhen 510385,Guangdong,China;Department of Intervention,the Second People's Hospital of Shenzhen(the First Affiliated Hospital of Shenzhen University),Shenzhen 510385,Guangdong,China;Department of Vascular Surgery,Shanghai Changhai Hospital(the First Affiliated Hospital of Naval Medical University),Shanghai 200433,China)

机构地区：[1]深圳市第二人民医院(深圳大学第一附属医院)血管外科,广东深圳510385 [2]深圳市第二人民医院(深圳大学第一附属医院)介入科,广东深圳510385 [3]上海长海医院(海军医科大学第一附属医院)血管外科,上海200433

出　　处：《血管与腔内血管外科杂志》2024年第6期677-680,690,共5页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨烟囱支架技术治疗近肾腹主动脉瘤(AAA)的近期疗效。方法收集2011年1月至2017年12月于深圳市第二人民医院(深圳大学第一附属医院)及上海长海医院(海军医科大学第一附属医院)接受烟囱支架技术治疗的20例近肾AAA患者的临床资料,术后3个月、6个月及1年通过腹主动脉超声及主动脉计算机断层扫描血管成像(CTA)观察瘤腔内有无活动性血流信号,并测量瘤体大小。结果20例近肾AAA患者烟囱支架技术成功率为100%,术中造影支架内血流通畅,手术前后肌酐水平比较,差异无统计学意义(P﹥0.05)。4例患者术中出现Ⅰ型内漏,2例患者出现Ⅱ型内漏,1例患者出现Ⅲ型内漏。随访(13.6±6.2)个月,6例患者随访时内漏消失,其他患者无新发内漏出现,肾动脉支架通畅率100%;随访期间1例患者于家中死亡,可能与内漏导致腹主动脉瘤破裂有关。结论烟囱支架技术治疗近肾腹主动脉瘤疗效安全可靠,性价比较高,较适用于高龄、急诊及经济状况一般患者。Objective To study the effectiveness of chimney graft technique in the treatment of near-renal abdominal aortic aneurysm(AAA).Method The clinical data of 20 patients with near-renal AAA who received chimney stent therapy in the Second People's Hospital of Shenzhen City(the First Affiliated Hospital of Shenzhen University)and Shanghai Changhai Hospital(the First Affiliated Hospital of Naval Medical University)from January 2011 to December 2017 were collected.Abdominal aortic ultrasound and aortic computed tomography angiography(CTA)were performed at 3 months,6 months and 1 year after surgery to observe the presence of active blood flow signals in the lumen,and the size of the tumor was measured.Result The success rate of chimney stent surgery in 20 patients with proximal renal AAA was 100%,the blood flow in the stent was unobstructed during the operation,and the creatinine level before and after the operation was compared,the difference was not statistically significant(P>0.05).Intraoperative internal leakage occurred in 4 patients with type I,2 patients with type II,and 1 patient with type III.During follow-up of(13.6±6.2)months,internal leakage disappeared in 6 patients,and no new internal leakage appeared in other patients.The patency rate of renal artery stent was 100%.During follow-up,one patient died at home,possibly due to ruptured abdominal aortic aneurysm caused by internal leakage.Conclusion The efficacy of chimney stent in the treatment of proximal renal abdominal aortic aneurysm is safe,reliable and cost-effective,which is more suitable for elderly,emergency and general economic status patients.

关 键 词：近肾腹主动脉瘤 烟囱支架技术 瘤体直径 手术时间 住院时间 

分 类 号：R543[医药卫生—心血管疾病]