腹主动脉-髂动脉瘤术中不同髂内动脉重建方式的结果分析  

Outcomes analysis of different internal iliac artery reconstruction techniques during abdominal aorto-iliac aneurysm repair

作　　者：王冕[1] 魏立泰 姚陈[1] 李梓伦[1] 武日东[1] 宁俊杰 吴伟滨 石毅 秦原森 崔进[1] 王斯文[1] 常光其[1] Wang Mian;Wei Litai;Yao Chen;Li Zilun;Wu Ridong;Ning Junjie;Wu Weibin;Shi Yi;Qin Yuansen;CuiJin;Wang Siwen;ChangGuangqi(Department of Vascular Surgery,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院血管外科,广州510080

出　　处：《中华血管外科杂志》2024年第5期313-318,共6页Chinese Journal of Vascular Surgery

基　　金：广东省自然科学基金项目(2023A1515010543);国家自然科学基金项目(82470513,82170510)。

摘　　要：目的探讨腹主动脉-髂动脉瘤患者术中不同髂内动脉重建方式的治疗结果。方法本研究为回顾性病例系列研究。回顾性分析2017年6月至2024年7月中山大学附属第一医院因腹主动脉-髂动脉瘤行髂内动脉重建术的77例患者的临床资料, 其中男性72例, 女性5例;年龄(66.4±9.1)岁(范围:38~83岁);包括单纯髂动脉瘤7例, 腹主动脉瘤累及髂动脉70例。动脉瘤最大直径为(58.1±16.1)mm。采用开放手术重建和腔内技术重建髂内动脉, 其中腔内技术包括"三明治"技术、医师改良支架移植物(PMEG)技术、商品化髂动脉分支支架(IBD)技术。出院后 1、3、6 个月及此后每年一次随访。记录和评估不同重建方式的手术情况、并发症情况及二次干预情况等。结果 77例行髂内动脉重建的患者中, 开放手术16例, 市售商品化IBD技术39例, "三明治"技术4例, PMEG技术18例。1例IBD重建右侧髂内动脉患者未成功, 改为IBD重建左侧髂内动脉;余76例均顺利完成手术(98.7%)。围术期死亡3例(3.9%), 包括开放手术、IBD技术及"三明治"技术各1例。61例腔内技术重建髂内动脉的患者中, 17例(27.9%)出现内漏, 其中Ⅰ型内漏1例, Ⅱ型14例, Ⅳ型2例。中位随访时间为16(6, 38)个月, 髂内动脉通畅率94.3%(66/70)。4例重建的髂内动脉发生闭塞, 但未导致缺血症状, 未进行二次干预。随访期间死亡2例, 其中开放手术和IBD技术(术后出现Ⅳ型内漏)各1例。无新发内漏, 16例原发内漏患者存活, 其中5例(均为Ⅱ型)内漏自行消失, 余11例内漏不同程度减少, 未导致瘤囊增大。无臀肌缺血、盆腔缺血发生。结论重建髂内动脉可有效预防臀肌、盆腔缺血, 各重建方式技术成功率均较高。Objective:To evaluate the outcomes of different internal iliac artery(IIA)reconstruction techniques for patients diagnosed with abdominal aortic-iliac aneurysms.Method:In this retrospective case series study,clinical data was analyzed from patients who underwent IIA reconstruction for abdominal aortic-iliac aneurysms at the First Affiliated Hospital,Sun Yat-sen University,from June 2017 to July 2024,including 77 patients(72 males and 5 females)with the mean age of 66.4±9.1 years old(38-83 years old).Among them,7 patients are with isolated iliac artery aneurysms and 70 with abdominal aortic aneurysms involving the iliac arteries.The mean maximum aneurysm diameter was(58.1±16.1)mm.The IIA reconstruction was conducted through open surgery or endovascular techniques,which included the"sandwich"technique,physician-modified endograft technique,and commercial iliac branch devices(IBD)technique.The follow-up was conducted 1,3,and 6 months after discharge and annually thereafter.The surgical conditions,complications,and re-interventions of different reconstruction techniques were recorded and evaluated.Results:Among 77 patients,16 underwent IIA reconstruction via open surgery,39 via the commercial IBD technique,4 via the"sandwich"technique,and 18 via the physician-modified endograft technique.One case of IBD reconstruction of the right IIA failed and was then converted to the left IIA.Among the rest of the 76 patients,the procedures succeeded with three perioperative fatalities(3.9%),including one via open surgery,IBD technique,and"sandwich"technique respectively.The endoleak rate of patients undergoing IIA reconstruction through endovascular technique was 27.9%(17 of the total 61 patients),including one case of type I,14 of typeⅡ,and 2 of typeⅣ.During a median follow-up period of 16 months(ranging from 6 to 38 months),the patency rate of the IIA was 94.3%(66 of the 70 patients).4 patients with reconstructed iliac arteries had occlusion but did not result in ischemic symptoms,thus no re-intervention was conducted.Me

关 键 词：腹主动脉瘤 髂动脉瘤 血管腔内修复术 髂内动脉重建 分支支架 

分 类 号：R57[医药卫生—消化系统]