腹主动脉瘤腔内修复术单中心经验

A single center＇s experience on endoluminal repair of abdominal aortic aneurysms

目的分析腔内治疗腹主动脉瘤的各项几何参数的分布规律，并探讨其远期疗效及术后常见并发症的防治方法。方法回顾性分析入选2003年1月至2010年12月完成的344例肾下腹主动脉瘤腔内修复病例资料，对原始数据及随访结果做统计学分析及比较。结果腹主动脉瘤近端瘤颈直径（23±3）mm，近端瘤颈长度（26±12）mm，与主动脉夹角（25±28）度。即刻技术成功率99．7％（343／344），随访率81．8％（279／341），随访时间3～84个月，平均（33±15）个月。随访期间死亡率1．1％（3／279），再次手术率10．4％（29／279），总并发症发生率12．9％（36／279），包括内漏5．7％（16／279），支架移位1．1％（3／279），动脉瘤增大或破裂5．4％（15／279）等。统计结果显示近端瘤颈〉60度更易出现I型内漏（P=0．010）。结论术前评估是腹主动脉瘤腔内治疗取得成功的首要因素。内漏是术后远期并发症的主要类型，且为再次手术的重要原因，影响患者的远期疗效，因此术后终身随访极为重要。

Objective To retrospectively analyze the geometrical characteristics of abdominal aortic aneurysms undergoing endovascular treatment in a single medical center. The long-term effects as well as the strategies for the prevention and treatment of complications have been reviewed. Methods From January 2003 to December 2010, clinical data and geometrical parameters of 344 cases undergoing endoluminal repair of abdominal aortic aneurysms were analyzed retrospectively. Results The diameter and length of proximal neck was （ 23 ± 3 ） mm and （ 26 ± 12 ） mm respectively. The angle between the neck and the abdominal aortic aneurysm was （ 25 ± 28 ） degree. The surgical success rate was 99. 7%. The average follow-up time was 32. 9 months （3 -84 months） with follow-up rate 81.8% （279/341）. The mortality was 1.1% （3/279）, the re-intervention rate was 10.4% （29/279） and the overall complication rate was 12. 9% （ 36/279 ）, including endoleak of 5.7% （ 16/279 ）, stent-graft migration of 1.1% （ 3/279 ）, aneurysm expansion or rupture of 5.4% （ 15/279 ） , and other complications like limb occlusion. Severe infrarenal aortic neck angulation （ 〉 60 degree） was associated with type I endoleak （P = 0. 010 ）. Conclusions A careful preoperative case selection and evaluation is the key for a successful endovascular aneurysm repair. Endoleak continues to be the major long-term complication of the endoluminal grafting technique, and the major cause for re-intervention. Life-long follow-up is extremely important.