凝血酶在预防腹主动脉瘤腔内修复术后内漏及促进瘤囊回缩中的作用  

The effect of thrombin in preventing endoleaks and promoting sac regression after endovascular repair of abdominal aortic aneurysm

作　　者：赵世录 栾景源[1] 冯琦琛[1] 庄金满[1] Zhao Shilu;Luan Jingyuan;Feng Qichen;Zhuang Jinman(Department of Interventional Vascular Surgery,Peking University Third Hospital,Beijing100191,China)

机构地区：[1]北京大学第三医院介入血管外科,北京100191

出　　处：《中华普通外科杂志》2024年第11期850-854,共5页Chinese Journal of General Surgery

基　　金：北京新兴卫生产业发展基金(XM2023-04-001)。

摘　　要：目的探讨凝血酶在预防腹主动脉瘤腔内修复术后内漏及促进瘤囊回缩中的效果。方法回顾性分析2018年5月至2023年5月因腹主动脉瘤就诊于北京大学第三医院介入血管外科行腔内治疗(endovascular repair,EVAR)的腹主动脉瘤患者,对内漏高危患者,在EVAR术中行凝血酶注射,观察手术成功率、围手术期(30 d)病死率及内漏发生率、有无凝血酶相关过敏反应及异位栓塞等。结果83例高危患者中,技术成功率为100%(83/83)。平均手术时间(89.9±17.1)min。平均住院时间(5.8±1.3)d。围手术期无凝血酶相关的过敏反应及异位栓塞。中位随访时间36个月。5例患者失访。随访期间3例患者死亡,其中2例分别在术后16个月及24个月时死于急性心肌梗死,1例患者于术后34个月死于肺癌。其余75例患者存活,整体存活率为96.2%(75/78)。75例患者中3例发生Ⅱ型内漏(4.0%),随访过程中瘤体最大直径及体积未见明显增加,予以观察保守治疗。75例患者中瘤体最大直径平均(43.8±7.4)mm,较术前(61.4±14.4)mm明显降低(P<0.001);瘤体体积较术前亦明显降低[(125.5±54.1)cm^(3)比(239.3±145.1)cm^(3),P<0.01]。结论在EVAR术中使用凝血酶预防及治疗内漏,在一定程度上是安全、有效的。在EVAR术后随访中,应该注重瘤囊体积变化。ObjectiveTo investigate the effect of thrombin in preventing endoleaks and promoting sac regression after endovascular repair of abdominal aortic aneurysm.MethodsRetrospective study was performed on patients with abdominal aortic aneurysm(AAA)who were admitted to Peking University Third Hospital for endovascular repair(EVAR)from May 2018 to May 2023.Thrombin injection was performed during EVAR in patients with high risk of endoleaks,and the success rate of the operation,perioperative mortality(30 d),incidence of endoleak,thrombin-related allergic reactions and ectopic embolism were observed.ResultsIn 83 patients,the technical success rate was 100%(83/83).The average operation time was(89.9±17.1)min.The average hospitalization was(5.8±1.3)days.There were no thrombin-related allergic reactions and ectopic embolism in peri-operation.The median follow-up time was 36 months.Five patients lost follow-up.During the follow-up period,3 patients died,of which 2 died of acute myocardial infarction at 16 and 24 months,respectively,and 1 died of lung cancer at 34 months.The remaining 75 patients survived,with an overall survival rate of 96.2%(75/78).TypeⅡinternal leakage occurred in 3 of the 75 patients,with an incidence of 4.0%.The maximum diameter and volume of the sac did not increase significantly during follow-up,and conservative treatment was performed.The mean maximum sac diameter of 75 patients was(43.8±7.4)mm,which was significantly lower than that of(61.4±14.4)mm before EVAR(P<0.001).The sac volume was also significantly decreased[(125.5±54.1)cm 3 vs.(239.3±145.1)cm 3,P<0.01].ConclusionsThe use of thrombin in the prevention and treatment of endoleak during EVAR is safe and effective after mid-term follow-up.In the follow-up of EVAR,attention should be paid to the change of sac volume.

关 键 词：腹主动脉瘤 凝血酶 腔内修复术 内漏 

分 类 号：R654.3[医药卫生—外科学]