规范急诊流程下破裂腹主动脉瘤腔内修复的近、中期疗效  

Short-and mid-term outcomes of endovascular repair for ruptured abdominal aortic aneurysms under standardized emergency protocols

作　　者：肖悦 郭媛媛 郭修海 陈澄 XIAO Yue;GUO Yuanyuan;GUO Xiuhai;CHEN Cheng(Department of Vascular Surgery,Fuwai Yunnan Hospital,Chinese Academy of Medical Sciences/Affiliated Cardiovascular Hospital of Kunming Medical University,Kunming 650102,China)

机构地区：[1]云南省阜外心血管病医院/昆明医科大学附属心血管病医院血管外科,云南昆明650102

出　　处：《中国普通外科杂志》2024年第12期1975-1982,共8页China Journal of General Surgery

基　　金：云南省科技厅重点研发计划基金资助项目(202403AC100004)。

摘　　要：背景与目的:腹主动脉瘤破裂(rAAA)是腹主动脉瘤最严重的并发症,病情发展迅速,病死率高,及时的诊断和治疗极其关键,目前腔内治疗作为一线选择。本文分析探讨规范急救流程下动脉瘤腔内修复术(EVAR)治疗rAAA的安全性、有效性,以及近、中期疗效。方法:回顾性分析2018年1月—2024年10月在云南省阜外心血管病医院接受EVAR的22例rAAA患者的临床资料。男16例,女6例,年龄(67.2±10.0)岁,瘤体最大径(70.6±9.2)mm,均为肾下型rAAA,瘤颈角度(107.9±54.3)°。所有患者术前均通过全主动脉+冠脉CT血管造影(CTA)确诊,所有患者在规范急救流程下行EVAR。收集患者围手术期临床资料,术后1周与1、6、12个月及之后每年1次随访CTA资料,分析瘤腔血栓化率、支架形态、内漏形式及发生率、髂分支通畅率等。结果:手术成功率为100%;术中支架植入后造影发生Ⅰ型内漏6例,通过球囊扩张、植入短支架及弹簧圈+生物蛋白胶填充瘤腔等技术处理,再次造影内漏消失或明显减少。平均手术时间(162.1±63.6)min,输悬浮红细胞(736.4±532.3)mL,术后外科重症监护病房治疗时间(8.76±1.0)h,平均住院时间(8.1±4.5)d。术后30 d死亡6例,2例患者术后1周复查CTA发现少许Ⅱ型内漏,未予特殊处理,术后1个月复查内漏减少,术后3~6个月,内漏消失;1例患者于术后2年发生Ⅰb型内漏,遂二次干预,内漏消失;其余患者支架无内漏,无髂支闭塞,瘤腔血栓化程度满意。结论:规范急救流程下EVAR治疗rAAA安全有效,近中期疗效满意,对于Ⅰ型内漏可借助球囊扩张、植入短支架及弹簧圈+生物蛋白胶填充瘤腔等技术予以处理,疗效安全可靠。Background and Aims:Ruptured abdominal aortic aneurysm(rAAA)is the most severe complication of abdominal aortic aneurysms,characterized by rapid progression and high mortality.Timely diagnosis and treatment are critical,with endovascular aneurysm repair(EVAR)currently serving as the first-line treatment.This study was conducted to evaluate the safety,efficacy,and short-to mid-term outcomes of EVAR for rAAA under standardized emergency protocols.Methods:The clinical data of 22 patients with rAAA who underwent EVAR at Yunnan Fuwai Cardiovascular Hospital from January 2018 to October 2024 were retrospectively analyzed.The cohort included 16 males and 6 females,with a mean age of(67.2±10)years.The mean maximum aneurysm diameter was(70.6+9.2)mm,and all cases were infrarenal rAAA with a mean aneurysm neck angle of(107.9±54.3)°.All patients were diagnosed preoperatively via total aortic and coronary computed tomography angiography(CTA)and treated with EVAR under standardized emergency protocols.Perioperative clinical data,along with follow-up CTA findings at 1 week,1 month,6 months,12 months,and annually thereafter,were collected.Outcome measures included aneurysm sac thrombosis rate,stent morphology,type and incidence of endoleaks,and iliac branch patency rate.Results:The procedural success rate was 100%.Intraoperative angiography revealed type I endoleak in 65 cases,which were successfully managed using balloon dilation,short stent implantation,or a combination of coil embolization and biologic glue to seal the aneurysm sac.Post-treatment angiography showed resolution or significant reduction of the endoleak.The mean operative time was(162.1±63.6)min,with an average transfusion of(736.4+532.3)mL of packed red blood cells.After operation,the average stay in the SICU was(8.76+1.0)h,and the mean hospital stay was(8.1±4.5)d.There were 6 deaths within 30 d after operation.Two patients had minor type II endoleak detected on CTA at 1 week,which required no special intervention;these endoleaks reduced by 1 month and reso

关 键 词：主动脉瘤 腹 动脉瘤 破裂 内漏 

分 类 号：R654.3[医药卫生—外科学]