腹主动脉瘤腔内修复术锚定区形态评估与临床结局的研究进展  

Advances in the study of morphological evaluation of the landing zone and clinical outcomes in endovascular aortic aneurysm repair

作　　者：栗嘉成 翁诚馨 赵纪春[1] 袁丁[1] LI Jiacheng;WENG Chengxin;ZHAO Jichun;YUAN Ding(Division of Vascular Surgery,Department of General Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;West China School of Medicine,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院普通外科血管外科病房,成都610041 [2]四川大学华西临床医学院,成都610041

出　　处：《中国普外基础与临床杂志》2024年第8期992-997,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家自然科学基金青年科学基金项目(项目编号:82300542)。

摘　　要：目的 总结远端锚定区形态与腹主动脉瘤腔内覆膜支架修复术后髂支不良事件关系的研究进展。方法 对近年来国内外在腹主动脉瘤腔内覆膜支架修复术中近远端锚定区几何形态对临床结局的影响、近远端锚定区相关并发症的评估方法、远端锚定区几何形态相关不良结局的预防措施、远端锚定区相关并发症的病理生理学机制的相关文献予以综述。结果 近端锚定区的不规则几何形态与腹主动脉瘤腔内治疗术后的不良事件密切相关,远端锚定区形态实际上比近端更为复杂且相关参数的测量方法也较为复杂,目前文献中对于锚定区研究常用的方法包括中心线距离法、最小距离法、锚定面积法。远端锚定区几何形态相关不良结局的主要预防措施包括增大径向支撑力及贴附面积、使用主动锚定系统、延长锚定区等手段。除了解剖学因素,远端锚定区还受到多种病理生理学因素的影响。结论 远端锚定区的形态及其相关病理变化对腹主动脉瘤腔内覆膜支架修复术后的临床结局具有显著影响。然而,目前关于远端锚定区的研究较少,未来的研究应当致力于开发新的技术和方法,以改善远端锚定区的评估和处理,进而减少腔内覆膜支架修复术后的并发症,提高手术的成功率和患者的生存质量。Objective To summarize the research progress of relationship between distal landing zone geometric and outcomes of endovascular aortic aneurysm repair(EVAR)for abdominal aortic aneurysm.Methods The domestic and foreign literature on the accumulation of the impact of proximal and distal landing zone geometric morphology on clinical outcomes,the evaluation methods for related complications of proximal and distal landing zones,preventive measures for adverse outcomes related to the geometric morphology of the distal landing zone,and the pathophysiological mechanisms of complications related to the distal landing zone were retrieved to make an review.Results The irregular geometric morphology of the proximal landing zone was closely associated with adverse events following EVAR.The morphology of the distal landing zone was actually more complex than that of the proximal zone,and the measurement methods for its parameters were also more complicated.Common methods used in the literature for studying landing zones included the centerline distance method,the minimum distance method,and the landing area method.Primary preventive measures for adverse outcomes related to the geometry of the distal landing zone included increasing radial support force and contact area,using endostaples,and extending the landing zone.In addition to anatomical factors,the distal landing zone was also influenced by various pathophysiological factors.Conclusions The morphology and related pathological changes of the distal landing zone significantly impact the clinical outcomes following EVAR for abdominal aortic aneurysm.However,current research on the distal landing zone is limited.Future studies should focus on developing new technologies and methods to improve the evaluation and management of the distal landing zone,thereby reducing the complications after EVAR,enhancing the success rate of the surgery,and improving patient survival quality.

关 键 词：腹主动脉瘤 锚定区几何形态 腔内覆膜支架修复术 髂肢不良事件 预防措施 

分 类 号：R654.3[医药卫生—外科学]