中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2011年
10期
883-887
,共5页
冯家烜%陆清声%景在平%杨阳%聂冰%包俊敏%赵志青%冯翔%洪毅%裴轶飞%袁良喜
馮傢烜%陸清聲%景在平%楊暘%聶冰%包俊敏%趙誌青%馮翔%洪毅%裴軼飛%袁良喜
풍가훤%륙청성%경재평%양양%섭빙%포준민%조지청%풍상%홍의%배질비%원량희
主动脉瘤,腹%血管假体植入%支架
主動脈瘤,腹%血管假體植入%支架
주동맥류,복%혈관가체식입%지가
Aortic aneurysm,abdominal%Blood vessel prosthesis implantation%Stents
目的 总结单中心应用纤维蛋白胶栓塞治疗腹主动脉瘤腔内隔绝术中Ⅰ型内漏的经验,研究其可行性及长期有效性.方法 2002年8月至2010年6月953例接受腹主动脉瘤腔内隔绝术的患者中,51例(5.4％)使用纤维蛋白胶栓塞术治疗术中Ⅰ型内漏.其中男性45例,女性6例,年龄49～88岁,平均年龄(72±8)岁.在栓塞术前后监测瘤腔内压力,在术后3、6和12个月及此后每年采用CT血管造影对患者进行随访.结果 经过栓塞治疗之后,50例(98.0％)Ⅰ型内漏消失,瘤腔内收缩压、舒张压、平均压、脉压差和平均压力指数均有明显降低.围手术期3例死亡(5.9％),其中1例高龄患者是由于Ⅰ型内漏无法消除,转开放手术后死于多器官功能衰竭;另2例死因与主动脉疾病无关.48例获得长期随访,中位随访时间45个月,腹主动脉瘤最大径从术前的(62±15)mm减至(49±10)mm(P =0.000).随访过程中3例患者死亡,其中1例死于瘤体持续增大压迫肾动脉造成的肾功能衰竭,另2例死因与主动脉无关;这3例患者随访期CT血管造影均未发现内漏.结论 纤维蛋白胶栓塞能有效治疗腹主动脉瘤腔内隔绝术中的Ⅰ型内漏,未见与栓塞治疗相关的并发症.在栓塞术前阻断内漏入口近端血流能增强该操作的安全性和有效性.
目的 總結單中心應用纖維蛋白膠栓塞治療腹主動脈瘤腔內隔絕術中Ⅰ型內漏的經驗,研究其可行性及長期有效性.方法 2002年8月至2010年6月953例接受腹主動脈瘤腔內隔絕術的患者中,51例(5.4％)使用纖維蛋白膠栓塞術治療術中Ⅰ型內漏.其中男性45例,女性6例,年齡49～88歲,平均年齡(72±8)歲.在栓塞術前後鑑測瘤腔內壓力,在術後3、6和12箇月及此後每年採用CT血管造影對患者進行隨訪.結果 經過栓塞治療之後,50例(98.0％)Ⅰ型內漏消失,瘤腔內收縮壓、舒張壓、平均壓、脈壓差和平均壓力指數均有明顯降低.圍手術期3例死亡(5.9％),其中1例高齡患者是由于Ⅰ型內漏無法消除,轉開放手術後死于多器官功能衰竭;另2例死因與主動脈疾病無關.48例穫得長期隨訪,中位隨訪時間45箇月,腹主動脈瘤最大徑從術前的(62±15)mm減至(49±10)mm(P =0.000).隨訪過程中3例患者死亡,其中1例死于瘤體持續增大壓迫腎動脈造成的腎功能衰竭,另2例死因與主動脈無關;這3例患者隨訪期CT血管造影均未髮現內漏.結論 纖維蛋白膠栓塞能有效治療腹主動脈瘤腔內隔絕術中的Ⅰ型內漏,未見與栓塞治療相關的併髮癥.在栓塞術前阻斷內漏入口近耑血流能增彊該操作的安全性和有效性.
목적 총결단중심응용섬유단백효전새치료복주동맥류강내격절술중Ⅰ형내루적경험,연구기가행성급장기유효성.방법 2002년8월지2010년6월953례접수복주동맥류강내격절술적환자중,51례(5.4％)사용섬유단백효전새술치료술중Ⅰ형내루.기중남성45례,녀성6례,년령49～88세,평균년령(72±8)세.재전새술전후감측류강내압력,재술후3、6화12개월급차후매년채용CT혈관조영대환자진행수방.결과 경과전새치료지후,50례(98.0％)Ⅰ형내루소실,류강내수축압、서장압、평균압、맥압차화평균압력지수균유명현강저.위수술기3례사망(5.9％),기중1례고령환자시유우Ⅰ형내루무법소제,전개방수술후사우다기관공능쇠갈;령2례사인여주동맥질병무관.48례획득장기수방,중위수방시간45개월,복주동맥류최대경종술전적(62±15)mm감지(49±10)mm(P =0.000).수방과정중3례환자사망,기중1례사우류체지속증대압박신동맥조성적신공능쇠갈,령2례사인여주동맥무관;저3례환자수방기CT혈관조영균미발현내루.결론 섬유단백효전새능유효치료복주동맥류강내격절술중적Ⅰ형내루,미견여전새치료상관적병발증.재전새술전조단내루입구근단혈류능증강해조작적안전성화유효성.
Objective To analyze the long-term results of fibrin glue embolization to eliminate type Ⅰ endoleaks after endovascular aneurysm repair (EVAR),and to assess the feasibility and durability of this technique.Methods From August 2002 to June 2010,among the 953 EVAR patients,51 ( 5.4％ )patients underwent intraoperative transcatheter fibrin glue sac embolization to resolve type Ⅰ endoleak persisting after initial intraoperative maneuvers to close the leak or in necks too short or angulated for cuff placement.Computed tomographic angiography was performed to assess the outcome after 3,6,and 12 months and annually thereafter.A retrospective study was conducted,and characteristics of the patients,intra-sac pressure,hospital course,and long-term outcomes were recorded. Results Among the 51 patients,19 (37.3％ ) patients had proximal necks long ＜10mm,and 6 ( 11.8％ ) patients had proximal neck angulation＞60°; 22 patients (3 additional iliac extension,14 cuffs,and/or 8 stents) had been placed with additional devices.After fibrin glue injection,50 (98.0％) of the 51 endoleaks were successfully resolved,and intra-sac pressure (including systolic,diastolic,mean pressures,pulse pressure,and the mean pressure indexes ) decreased significantly in these cases.The patient who failed embolotherapy was converted to open surgery (2.0％) ; he died 2 months later from multiorgan failure.And other two (4.8％) patients died in the peri-operative period from myocardial infarction.The median of follow-up of 48 patients was 45 months (range 4-106 months).The mean maximal aneurysm diameter fell from the baseline (61.5±15.2)mm to (48.8 ± 10.1 ) mm (P=0.000).Three (6.2％ ) patients died in the follow-up duration (1 aneurysm-related,died of renal failure which was caused by the compromised renal artery).Cumulative survival was 97.9％ at 1 year,94.5％ at 3 years,and 90.8％ at 4 years.No recurrent type Ⅰ endoleak or glue-related complications were observed in follow-up.Conclusions Fibrin glue embolization to eliminate type Ⅰ endoleak after EVAR has yielded promising results in this study,and it can effectively and durably resolve the type Ⅰ endoleaks.Balloon occlusion of the inflow of the endoleak must be done during glue injection,to enhance the safety and facilitate formation of a structured fibrin clot.
