摘要
目的探讨腹主动脉瘤腔内修复术(endovascular aortic aneurysm repair,EVAR)并发症的预防措施和再次手术的处理方法。方法对2006年8月至2019年9月大理大学第三附属医院完成的170例EVAR手术患者进行定期电话随访,观察患者术后并发症发生情况,对再次手术干预的病例进行统计分析。结果 170例中136例得到随访,失访34例,随访率为80%。136例患者中发生并发症15例,术后并发症发生率11.0%(15/136)。其中再次干预了9例,干预率6.6%(9/136)。再次手术干预的患者中近端内漏3例,行cuff支架2例和弹簧圈栓塞1例,远端内漏1例行支架延长;肠系膜下动脉返血1例行腹腔镜下肠系膜下动脉结扎;左髂支回缩入瘤腔1例行支架延长;髂支血栓2例,行取栓1例,1例行股股转流;髂支狭窄1例行支架延长。近端内漏行cuff支架中的1例,2年后因左侧髂支血栓阻塞,主体支架内血栓再次行人工血管置换;近端内漏弹簧圈栓塞术后5月动脉瘤破裂死亡。结论对EVAR病例术后定期进行随访及时发现问题,对需要再次干预的病例大部分可以通过腔内修复及时处理,EVAR也能够取得较好的中远期治疗效果。
Objective To investigate the preventive measures and the management for the complications of endovascular aortic aneurysm repair(EVAR).Methods Following up by telephone and retrospective analyzing170 patients undergone EVAR surgery in the Third Affiliated Hospital of Dali University between August 2006 and September 2019,the relevant data of the postoperative complications and the cases of reoperation were studied.Results 136 of the 170 cases were followed up and 34 cases were lost and the follow-up rate is 80%.15 of the136 patients had postoperative complications,with a rate of 11.0%(15/136).Among followed up patients,9 cases were re-intervened,with a reoperation rate of 6.6%(9/136).Among the 9 patients with reintervention,3 had proximal endoleak(2 added cuff stenting for 2 patients and 1 had spring-ring embolization);1 underwent laparoscopic ligation of the inferior mesenteric artery for type II endoleak of inferior mesenteric artery;2 had iliac branch thrombosis(1 had embolectomy and 1 had femoral-femoral bypass);3 had stent lengthening because of distal endoleak,iliac branch stenosis or left iliac branch retraction into the lumen of the aneurysm.Especially,2 case of proximal endoleak which added cuff stent,one case underwent artificial vessel replacement,due to the left iliac branch thrombus embolization and main body stent thrombosis after 2 years of first reoperation.Another case performed spring coil embolization again because of proximal endoleak and died of abdominal aneurysm rupture 5 months after the third operation.Conclusion Regular postoperative follow-up of EVAR cases can find postoperative complications earlier,most of the cases requiring re-intervention could be treated promptly by endovascular repair and so that EVAR could achieve a good medium-and long-term prognosis in abdominal aneurysm.
作者
马君
周建华
李梅
尹文俊
李勇
段旭娟
MA Jun;ZHOU Jian-hua;LI Mei;YIN Wen-jun;LI Yong;DUAN Xu-juan(Department of vascular surgery,the third affiliated hospital of Dali university,671000 Dali,China)
出处
《中国心血管病研究》
CAS
2022年第1期47-51,共5页
Chinese Journal of Cardiovascular Research
基金
云南省教育厅科学研究基金项目(2021J0374)。
关键词
腹主动脉瘤
腔内
随访
预防
再手术
Abdominal aortic aneurysm
Endovascular
Follow-up
Prevention
Reoperation
