腹主动脉瘤腔内修复术中远期随访分析

Mid-and long-term follow-up analysis of endovascular aneurysm repair of abdominal aortic aneurysm

目的探讨腹主动脉瘤腔内修复术(EVAR)的中远期治疗效果。方法收集2006年8月至2020年3月大理白族自治州人民医院收治的170例行EVAR治疗的肾下型腹主动脉瘤患者的临床资料,对全部患者进行随访,并对患者的围手术期病死率、中远期并发症发生率和二次手术干预率等指标进行分析。结果170例患者的随访率为80.0%。随访期间,全因死亡率为12.5%,生存率为87.5%。在有效随访的136例患者中,腹主动脉瘤相关病死率为1.5%。术后第13天,以及术后第3、12、24个月发生Ⅰ型内漏患者5例;术后第6个月发生Ⅱ型内漏患者1例;术后第3个月发生Ⅲ型内漏患者1例;术后第4天、第15天、第24个月发生支架内血栓形成患者3例;术后第3个月发生右髂动脉支架狭窄患者1例;术后第1个月发生支架移位患者1例。二次干预率为6.6%。结论随着术后随访工作的进一步精细化、标准化、长期化,可以实现对EVAR后并发症的及早发现和及时干预,同时操作水平的提高能够提升中远期手术效果。

Objective To investigate the mid-and long-term therapeutic effect of endovascular aneurysm repair(EVAR)of abdominal aortic aneurysm.Method A total of 170 patients undergoing EVAR of abdominal aortic aneurysm between August 2006 and March 2020 were followed up by Dali Bai Autonomous Prefecture People’s Hospital.Their perioperative mortality,mid-and long-term complication rates,secondary surgical intervention rates,and other indicators were analyzed.Result The follow-up rate was 80.0%among all 170 patients.During the follow-up,all-cause mortality was 12.5%and overall survival was 87.5%.Among 136 patients with effective follow-up,abdominal aortic aneurysmrelated mortality was 1.5%.On the 13th day,3 months,12 months,and 24 months after the surgery,5 patients had type I endoleak;1 patient had type II endoleak at 6 months after the surgery;1 patient had typeⅢendoleak at 3 months after the surgery;3 patients suffered stent thrombosis on the 4th day,15th day,and 24 months after the surgery;1 patient fell right iliac artery stent stenosis at 3 months after the surgery;1 patient experienced stent displacement at 1 month after the surgery.The secondary intervention rate was 6.6%.Conclusion As the further refinement,standardization,and long-term follow-up is conducted,early detection and timely intervention of postoperative complications of EVAR could be realized.At the same time,the improvement of the surgery would also be a benefit to the mid-and long-term surgical effect.