关于腹主动脉瘤腔内修复术中预防性栓塞肠系膜下动脉和腰动脉的分析与探讨  

Analysis and discussion of prophylactic embolization of inferior mesenteric artery and lumbar artery in endovascular abdominal aortic aneurysm repair

作　　者：郭强[1] 史潇兮 方坤 董智慧[4] 杨轶[1] 赵纪春[1] 舒畅 李鑫[5,6,7] GUO Qiang;SHI Xiaoxi;FANG Kun;DONG Zhihui;YANG Yi;ZHAO Jichun;SHU Chang;LI Xin(Division of Vascular Surgery,Department of General Surgery,West China Hospital,Sichuan University,Chengdu 610041,China;Department of General Surgery(Vascular and Thyroid Surgery),the First Hospital of China Medical University,Shenyang 110001,China;Department of Vascular Surgery,Fuwai Hospital,Chinese Academy of Medical Science,Beijing 100037,China;Department of Vascular Surgery,Zhongshan Hospital,Institute of Vascular Surgery,Fudan University,Shanghai 200032,China;Department of Vascular Surgery,the Secondary Xiangya Hospital,Central South University,Changsha 410013,China;Institute of Vascular Diseases,Central South University,Changsha 410013,China;Department of Vascular Surgery,Guilin Hospi Secondary Xiangya Hospital,Central South University(National Medical Center),Guilin,Guangxi 541002,China)

机构地区：[1]四川大学华西医院血管外科,四川成都610041 [2]中国医科大学附属第一医院普通外科(血管外科/甲状腺外科),辽宁沈阳110001 [3]中国医学科学院阜外医院血管外科,北京100037 [4]复旦大学中山医院血管外科,上海200032 [5]中南大学湘雅二医院血管外科,湖南长沙410013 [6]中南大学血管病研究所,湖南长沙410013 [7]中南大学湘雅二医院桂林医院(国家区域医疗中心)血管外科,广西桂林541002

出　　处：《中国普通外科杂志》2024年第12期2058-2061,共4页China Journal of General Surgery

摘　　要：动脉瘤腔内修复术(EVAR)是治疗腹主动脉瘤(AAA)的重要手段,但术后Ⅱ型内漏(T2EL)是最常见的并发症之一。T2EL主要由肠系膜下动脉(IMA)和腰动脉(LA)等侧支血管的反流血持续灌注动脉瘤囊所致。尽管T2EL可能导致瘤囊增大甚至破裂,但其总体危害较小,大多数病例可通过观察或微创手术进行有效处理。目前,预防性栓塞IMA和LA在降低T2EL发生率方面的效果尚不明确,且可能增加手术时间、辐射剂量和相关并发症发生风险。更重要的是,国内外权威指南均未推荐EVAR术中常规进行IMA和LA的预防性栓塞。针对T2EL高风险患者是否应进行预防性栓塞仍存争议,且相关研究多为小样本或单中心回顾性分析,证据级别有限。本文结合现有研究,从T2EL的危害性、预防性栓塞的效果及其临床指南推荐等方面进行总结分析,以期为EVAR术后T2EL的个体化管理提供参考依据。Endovascular aneurysm repair(EVAR)is a key treatment for abdominal aortic aneurysms(AAA),but type II endoleak(T2EL)is one of the most common postoperative complications.T2EL mainly arises from retrograde blood flow from collateral vessels such as the inferior mesenteric artery(IMA)and lumbar arteries(LA),which continue to perfuse the aneurysm sac.Although T2EL may lead to aneurysm sac enlargement or even rupture,its overall clinical impact is relatively minor,and most cases can be effectively managed through observation or minimally invasive interventions.Currently,the efficacy of prophylactic embolization of the IMA and LA in reducing the incidence of T2EL remains uncertain and may increase operative time,radiation exposure,and the risk of associated complications.More importantly,authoritative guidelines,both domestic and international,do not recommend routine prophylactic embolization of the IMA and LA during EVAR.Whether prophylactic embolization should be performed in high-risk patients for T2EL remains controversial,with most studies in this area being small-sample or single-center retrospective analyses,offering limited evidence quality.This article analyzes the harm of T2EL,the effectiveness of prophylactic embolization,and relevant guideline recommendations based on existing research,aiming to provide a reference for the individualized management of T2EL following EVAR.

关 键 词：主动脉瘤 腹 内漏 栓塞 治疗性 

分 类 号：R654.3[医药卫生—外科学]