国产血管内裸支架介入治疗假性腹主动脉瘤的研究

Study of interventional therapy for the false abdominal aneurysms by domestic endovascular stents

目的 探讨国产血管内支架对假性腹主动脉瘤的治疗作用。方法 健康杂种犬 3 2条均分为 4组 (组Ⅰ～Ⅳ ) ,对照组为组Ⅰ ,实验组按腹主动脉前壁切开长度不同分为组Ⅱ～Ⅳ。外科方法建立腹主动脉瘤模型后行介入治疗并行影像学和肉眼检查。结果 影像学检查 :组Ⅰ即对照组瘤腔存在 ;组Ⅱ瘤腔已闭合 ;组Ⅲ残留一小瘤腔 ;组Ⅳ显示一大的瘤腔 ,支架无移位。肉眼检查显示 :组Ⅰ :腹主动脉破裂口存在 ;组Ⅱ :腹主动脉破裂口已被支架和新生内膜完全覆盖 ,瘤腔内充满条索状机化物 ;组Ⅲ :破裂口几乎被支架和新生内膜所覆盖 ,仅遗留有一直径约 1 .0cm的小瘤腔 ,但瘤壁呈向心性增厚 ;组Ⅳ :破裂口仅部分被支架和新生内膜所覆盖 ,中央处遗留有直径 1 .0～1 .5cm破裂口未被新生内膜覆盖 ,仍有一大瘤腔。结论 国产网孔面积为 4.3mm2 的镍钛形状记忆合金血管内裸支架 ,对瘤腔入口≤ 1cm的腹主动脉瘤有治疗作用 ;瘤腔入口 >1cm但≤ 2cm可防止动脉瘤继续扩张和迟发破裂 ;瘤腔入口≥ 3cm则无任何治疗作用。

Objective To observe the effect of the domestic endovascular stent on the false abdominal aneurysm.Methods Thirty two healthy mongrel dogs were divided into four groups according to the designed standard. The models of false abdominal aneurysm were created surgically. The stents were impanted to treat the false abdominal aneurysms after 14 days. All dogs monthly underwent CT scanning until 6 months. All of them were killed after abdominal aortography.The gross specimen of the aneurysms was observed by naked eye.Results Image examination showed that the sacs existed in group Ⅰ(control group ); no flow to the sacs was seen at the 1st,2nd,3rd and 4th month in group Ⅱ, respectively; a small sac (with diameter about 1.0?cm) was seen in all dogs in group Ⅲ; a large sac was seen in all dogs in group Ⅳ. By the way of naked eye, the lacerated foramens of the abdominal artery existed in group Ⅰ,completely covered by neointima and stent in group Ⅱ,almost covered by neointima and stent except for 1 4 micropores connected with the small sacs in the group Ⅲ, and the walls of the small sacs were concentrically thickened. There were the defects in the center of the lacerated foramens of the abdominal artery diameter being about 1.0 1.5?cm in the group Ⅳ.Conclusion The demestic endovascular stent with the pore size being 4.3?mm 2 appears to be a suitable device to instantly exclude the false abdominal aneurysms (the lacerated length≤1?cm). The same stent appeared to has the possibility of preventing expansion and postponed rupture to aneurysms (1cm<the lacerated length≤2?cm).The stent didn't have any effect on the aneurysms with the lacerated length≥3?cm.