腹主动脉瘤腔内修复术覆膜支架远端锚定区的选择和评估方法及进展  

Selection and evaluation methods and progress of the distal landing zone of stent grafts for endovascular aortic repair of abdominal aortic aneurysms

作　　者：李思璇 严响 陈钇潜 陈镜全 张雷 张昊 Li Sixuan;Yan Xiang;Chen Yiqian;Chen Jingquan;Zhang Lei;Zhang Hao(Department of Vascular Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Department of Vascular Surgery,Changhai Hospital Affiliated to Naval Medical University,Shanghai 200433,China;Department of Clinical Medicine,North Sichuan Medical College,Nanchong 637000,China;Department of Neurosurgery,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]川北医学院附属医院血管外科,南充637000 [2]海军军医大学附属长海医院血管外科,上海200433 [3]川北医学院临床医学系,南充637000 [4]川北医学院附属医院神经外科,南充637000

出　　处：《中华胸心血管外科杂志》2025年第2期121-128,共8页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：上海市2021年度“科技创新行动计划”(21Y11909200)。

摘　　要：腹主动脉瘤(abdominal aortic aneurysm,AAA)是一类极其凶险的主动脉扩张性疾病,一旦发生破裂,死亡率极高。随着计算机断层扫描血管造影(Computed tomography angiography,CTA)等检查手段的提高,其疾病检出率也相应增加。早期发现并及时治疗对降低死亡率,改善患者预后,至关重要。相比于传统开放手术,腹主动脉瘤腔内修复术(endovascular aortic repair,EVAR)更加微创,其使用覆膜支架整体隔绝主动脉瘤瘤腔,防止动脉血进入瘤腔,进而防止动脉瘤进一步进展、破裂。基于EVAR的手术特点,需要术前对AAA解剖结构精准评估,制订手术方案,以选择合适的支架直径和长度。但是,目前关于EVAR术前评估更多的关注点在于瘤颈锚定区及形状、钙化情况等,而对于髂动脉远端锚定区的选择及位置判断关注相对较少且缺乏统一的标准,然而,越来越多的研究表明远端锚定区处理不当,可能会导致Ⅰb型内漏及支架术后再狭窄等并发症,影响患者预后。本文就目前国内、外EVAR术前对远端锚定区的评估方法及进展作一综述。Abdominal aortic aneurysm(AAA)is an extremely dangerous aortic dilating disease,with a high mortality rate once ruptured.With the advancement of imaging techniques such as computed tomography angiography(CTA),the detection rate of this disease has increased correspondingly.Early detection and timely treatment are crucial for reducing mortality and improving patient prognosis.Compared to traditional open surgery,endovascular aortic repair(EVAR)for AAA is minimally invasive,using a stent graft to isolate the aneurysm sac as a whole,preventing arterial blood from entering the sac and further preventing the aneurysm from progressing or rupturing.Due to the characteristics of EVAR,precise preoperative assessment of AAA anatomy is required to develop a surgical plan for selecting the appropriate stent diameter and length.However,current attention on preoperative assessment of EVAR is more focused on the neck landing zone of the aneurysm,its shape,calcification,etc.,while there is relatively less attention and lack of uniform standards for the selection and positioning judgment of the distal landing zone of the iliac artery.And,a growing number of studies have shown that improper treatment of the distal landing zone may lead to complications such as typeⅠb endoleak and restenosis after stent implantation,affecting the prognosis of patients.This article provides a review of the current domestic and international methods and progress in the preoperative assessment of the distal landing zone for EVAR.

关 键 词：覆膜支架 主动脉瘤 疾病检出率 锚定区 手术特点 手术方案 髂动脉 位置判断 

分 类 号：R65[医药卫生—外科学]