经皮穿刺入路腔内修复腹主动脉瘤使用ProGlide缝合的效果

CLINICAL EFFECT OF PROGLIDE SUTURE IN ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM REPAIR VIA PERCUTANEOUS PUNCTURE

目的探讨经皮穿刺入路行腹主动脉瘤腔内修复术(EVAR)使用ProGlide缝合的效果。方法我院2015年5月—2017年8月行EVAR治疗的腹主动脉瘤(AAA)病人179例,其中传统股总动脉切开入路104例(A组),使用ProGlide经皮入路75例(B组)。比较两组手术入路闭合成功率、手术入路相关并发症、手术及住院时间等。股总动脉穿刺点缝合顺利完成无需额外的外科及介入手段干预视为入路闭合成功。结果所有病人均成功实施了EVAR。A组208条股总动脉中行补片修补1条,闭合成功率为99.5%(207/208);相关并发症包括切口出血2条,切口感染1条,淋巴漏2条,感觉异常1条,术后管腔轻-中度狭窄2条。B组150条股总动脉中146条使用ProGlide闭合成功,闭合成功率为97.3%,2条股总动脉闭合失败中转外科切开缝合,2条股总动脉皮下血肿形成进一步行外科修复;相关并发症包括术后渗血1条,假性动脉瘤2条。两组手术入路并发症总体发生情况比较,差异无统计学意义(P>0.05)。B组手术及住院时间较A组均明显缩短,差异具有统计学意义(t=6.12、7.04,P<0.01)。结论经皮穿刺入路行EVAR使用ProGlide缝合安全可靠,并不增加手术入路相关并发症,且可明显缩短手术及住院时间,值得临床推广应用。

Objective To investigate the clinical effect of ProGlide suture in endovascular abdominal aortic aneurysm repair(EVAR)via percutaneous puncture.Methods A total of 179 patients with abdominal aortic aneurysm who underwent EVAR in our hospital from May 2015 to August 2017 were enrolled,and among these patients,104 underwent EVAR via common femoral artery incision(group A)and 75 underwent EVAR with ProGlide via percutaneous puncture(group B).The two groups were compared in terms of the success rate of surgical incision closure,complications associated with the surgical approach,time of operation,and length of hospital stay.Successful surgical incision closure referred to successful suture of the puncture point of the common femoral artery,without the need for further surgical or interventional measures.ResultsAll patients underwent a successful EVAR surgery.Patch repair was performed for 1 out of the 208 common femoral arteries in group A,and the success rate of surgical incision closure was 99.5%(207/208);related complications included incision bleeding in 2 arteries,incision infection in 1 artery,lymphorrhagia in 2 arteries,paresthesia in 1 artery,and mild-to-moderate angiostenosis in 2 arteries.Among the 150 common femoral arteries in group B,146 were successfully closed with ProGlide suture,with a success rate of 97.3%;2 common femoral arteries were converted to surgical incision and suture due to failed closure with ProGlide,and surgical repair was performed for 2 common femoral arteries due to subcutaneous hematoma;related complications included oozing of blood in 1 artery and pseudoaneurysm in 2 arteries.There was no significant difference in the incidence rate of complications between the two groups(P>0.05).Group B had significantly shorter time of operation and length of hospital stay than group A(t=6.12,7.04,P<0.01).Conclusion ProGlide suture is safe and reliable in EVAR via percutaneous puncture and does not increase the complications associated with surgical approach.It can also significantly shorten time of operation and length of hospital stay and thus holds promise for clinical application.