胸、腹主动脉瘤腔内隔绝术的临床应用

Clinical Study of Endovascular Graft Exclusion for Abdominal and Thoracic Aortic Aneurysms

目的:总结腔内隔绝术治疗胸、腹主动脉瘤的初步临床经验,探讨其指征、方法、操作要点及临床应用前景.方法:本组15例患者在DSA监视下经股总动脉小切口将人造血管内支撑复合体(移植物)导人腹主动脉瘤,从腔内将瘤体与血流隔绝.15例中置入直管型移植物4例,分叉型移植物11例.结果:13例患者于手术当日进食,次日下床活动;1例出现急性酸中毒;1例因髂动脉扭曲导致移植物将髂动脉阻塞,而加作股.股交叉转流术,恢复较慢.4例出现内漏,其中1例3月后自行愈合;1例术后第4天动脉瘤破裂,经传统开腹手术治愈;另2例随访中.2周及3月后分别复查彩超、螺旋CT.结果显示全部病例移植物中血流通畅,无移位.结论:腔内隔绝术简捷、方便,避免了常规开腹手术所见腹部及重要脏器并发症,创伤小、恢复快,适用于所有尤其是高龄高危肾下腹主动脉瘤及胸降主动脉瘤患者.全程内支架-人造血管复合体应用于EVGE效果良好.熟练的导管操作技巧及精确的术前评估有利于提高操作成功率及减少术后并发症.并发内漏的问题有待于继续观察探讨.

Objective: To evaluate the indication, methods, operating essentials and clinical prospects of endo-vascular graft exclusion(EVGE). Methods: 15 patients with abdominal and thoracic aortic aneurysm (AAA & TAA) and dissecting aortic aneurysm(DAA) were performed EVGE. Dacron(graft)-stent complex was introduced via femoral arteries into the lumen of the sac and deployed at the neck of aneurysm, thus the aneurysm was excluded from the blood circulation. 4 tubular and 11 bifurcated grafts were deployed. Results: 13 patients ate normally at the operating day and got up to move at the day after operation. Endoleaks appeared in 4 cases, in which 1 disappeared 3 months later, 1 AAA ruptured 4 days after operation and was cured with open method, 1 acidosis, 1 iliac artery obstruction. Follow-up: Detecting with ultrasound and spiral CT in 2 weeks and 3 months after the procedures respectively showed that the blood flow was fluent and no graft migration. Conclusions: The key point to success lies on the accurate evaluation before operation. Suitable graft must been selected to fit the parameters of the aneurysms. Highly developed skills mastered by the operator can lead to an easy success of the procedure. Due to less invasion and less complications, EVGE has a bright clinical prospects.