Ⅱ型内漏的治疗和预防方法及其应用材料的研究进展

Progress on treatment and prevention of type Ⅱ endoleak and its available materials

型内漏是腹主动脉瘤腔内修复术(EVAR)后的常见并发症,严重影响着EVAR后的远期结果。目前,治疗Ⅱ型内漏的手术方法有很多,主要包括腔内手术方法(如经动脉途径、经腰途径、经腔静脉途径等)和开放手术方法(如开放手术、腹腔镜等)。腔内手术具有较高的技术难度和复发率,而开放手术的并发症发生率和病死率均较高。随着如何治疗Ⅱ型内漏这个难点问题的突显,如何有效预防Ⅱ型内漏成为近年来的研究热点。然而,无论是Ⅱ型内漏的治疗方法,还是Ⅱ型内漏的预防方式,国内外的指南或共识目前均无统一标准。另外,治疗或预防Ⅱ型内漏所使用的材料种类繁多,主要包括固体栓塞材料(如弹簧圈、血管塞等)和液体填充材料[如纤维蛋白胶、凝血酶类填充剂、α-氰基丙烯酸正丁酯(NBCA)和Onyx胶等]。不同种类的栓塞或填充材料具有各自的优点和劣势,但相关的综述尚缺乏。本文旨在对Ⅱ型内漏治疗和预防的手术方法及其应用材料的研究进展进行文献回顾,以期为临床医师在临床决策过程中选择最佳方案提供参考。

TypeⅡendoleak,as the common complication after endovascular aneurysm repair(EVAR),affects the longterm outcome after EVAR.Currently,there are many treatments of type II endoleak,mainly including endovascular treatments(such as transarterial way,translumbar way and transcaval way)and open surgical treatments(such as open surgery and laparoscopy).Endovascular treatments show a higher technical difficulty and recurrence rate of typeⅡendoleak,while open surgical treatments show higher complications and mortality.With the rising attention on difficulty of typeⅡendoleak treatment,how to prevent typeⅡendoleak effectively has become a hot issue in recent years.However,no matter whether it is treatment or prevention of type II endoleak,there is still no standard at present in domestic and foreign guidelines.There are many types of materials used in treatment or prevention of typeⅡendoleak,mainly including solid materials(such as coils and vascular plugs)and liquid filling materials[such as fibrin glue,thrombin filler,N-butyl cyanoacrylate(NBCA)and Onyx],all of which enjoy their own advantages and disadvantages,but the relevant reviews are limited.The paper reviews the treatment and prevention of type II endoleak and its available materials to help clinicians choose the optimal options in decision-making.