腹主动脉瘤腔内修复术后各型内漏相关性分析（附272例报告）

doi:10.16139/j.1007-9610.2018.03.018

摘要/Abstract

摘要： 目的: 探讨腹主动脉瘤（abdominal aortic aneurysm, AAA）腔内修复术后发生内漏的危险因素。方法: 回顾性分析2014年1月至2015年10月272例AAA病人行腔内修复术的临床资料和术后3、6、12、24、36个月随访结果。分析腔内修复术后各型内漏发生率及其与临床特征、支架类型、动脉瘤颈结构的关系。结果: 272例病人腔内修复术后内漏总发生率为15.8%(43/272),其中Ⅰ、Ⅱ、Ⅲ或Ⅳ型以及张力性内漏（Ⅴ型）的发生率分别为7.4%(20/272)、6.3%(17/272)、1.5%(4/272)和0.7%(2/272)。Ⅰ型内漏多在随访3个月时发现,而其他类型内漏在随访12个月或更晚发现。动脉瘤近端瘤颈短（<1.5 cm）、重度扭曲（>45°）、形状不规则或钙化程度高（>25%）与Ⅰa型内漏发生显著相关（P<0.05）。持续通畅的肠系膜下动脉以及存在≥2根罪犯血管是Ⅱ型内漏发生的危险因素（P<0.05）。年龄、美国麻醉医师协会（American Society of Anesthesiologists, ASA）病情分级、吸烟以及合并高血压、糖尿病、冠心病、肺部疾病等对内漏发生率无影响。不同类型的人工血管支架对内漏发生有显著影响（P=0.047）。与其他类型支架相比,Endurant支架的内漏发生率最低（10.7%）。结论: 制定腔内修复手术方案时,应充分评估AAA的特征和内漏风险,以期达到较好的疗效。

关键词: 腹主动脉瘤, 内漏, 腔内修复

Abstract: Objective: To investigate the risk factors for endoleaks after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA). Methods: A total of 272 patients with AAA undergoing EVAR from January 2014 to October 2015 were retrospectively analyzed. The patients were followed up at postoperative 3, 6, 12, 24, and 36 months. The endoleak incidence and the association of endoleak with clinical characteristics, stent graft type and anatomic geometry of aneurysm neck were analyzed. Results: The incidence of endoleaks after EVAR in 272 patients with AAA was 15.8% (43/272) with 7.4% (20/272), 6.2% (17/272), 1.5% (4/272) and 0.7% (2/272) for type Ⅰ, Ⅱ, Ⅲ+Ⅳ and Ⅴ (endotension), respectively-Type Ⅰ endoleak was found mostly during 3-month of follow-up, and the other endoleaks during 12-month of follow-up or longer. Short proximal neck length of aneurysm (<1.5 cm), oversize degree (>45°), irregular shape, and high calcification (>25%) were significantly associated with an increased incidence of type Ⅰa endoleak (P<0.05). Patent inferior mesenteric artery and ≥2 crime arteries were the risk factors for type Ⅱ endoleak (P<0.05). Clinical characteristics, including age, ASA status, smoking status, and comorbidities such as hypertension, diabetes, coronary artery disease and pulmonary disease had no impact on endoleak. However, stent graft type was associated with the incidence of overall endoleak significantly (P=0.047). Endurant showed to be used with the lowest incidence of endoleak (10.7%) when compared with other stent graft types. Conclusions: To avoid endoleak, physicians should evaluate the characteristics of AAA and assess the risks for endoleak when planning an EVAR.

Key words: Abdominal aortic aneurysm, Endoleak, Endovascular aortic repair

中图分类号:

R543.1⁺6

康鹏飞, 毛乐, 竺挺, 符伟国. 腹主动脉瘤腔内修复术后各型内漏相关性分析（附272例报告）[J]. 外科理论与实践, 2018, 23(03): 274-278.

KANG Pengfei, MAO Le, ZHU Ting, FU Weiguo. Analysis of different types of endoleak after endovascular repair for abdominal aortic aneurysm: a report of 272 cases[J]. Journal of Surgery Concepts & Practice, 2018, 23(03): 274-278.

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