腔内隔绝术在破裂性腹主动脉瘤治疗中的应用

Application of endovascular exclusion in treatment of ruptured abdominal aortic aneurysm

关键词:  腔内隔绝术  腹主动脉瘤  支架

Key words:  endovascular repair  abdominal aortic aneurysm  stent

摘要:

[目的]总结腔内隔绝术治疗破裂性腹主动脉瘤的经验。[方法]收集2005年1月-2011年3月采用腔内隔绝术治疗破裂性腹主动脉瘤的16例患者的临床资料。所有患者行数字减影血管造影（DSA）和/或螺旋CT 血管成像检查确诊。在DSA指导下，经股动脉小切口将支架移植物导入腹主动脉内，从腔内将瘤体与血流隔绝。[结果]16例腹主动脉瘤腔内隔绝术获成功。术后死亡2 例（病死率为12.5%），分别死于瘤体破裂和感染性休克。3例患者发生内瘘，1个月后自行封闭。[结论]腹主动脉瘤腔内隔绝术是安全有效的方法，其治疗成功的关键主要在于了解动脉瘤的解剖形态以及操作的准确和熟练。

Abstract:

[Objective] To summarize clinical practice of endovascular exclusion in patients with ruptured abdominal aortic aneurysms. [Methods] From January 2005 to March 2011, 16 cases of abdominal aortic aneurysm were treated with endovascular exclusion in the Second Affiliated Hospital of Harbin Medical University. Their diagnosis was confirmed by digital subtraction angiography (DSA) and spiral computed tomography angiography. In order to isolate the body of abdominal aortic aneurysm from blood flow, under the guidance of DSA, stent graft was introduced into the abdominal aorta from a small incision of the femoral artery. [Results] Sixteen cases of abdominal aortic aneurysm were performed endovascular exclusion successfully, including two cases of fenestrations of stent. Two cases died after the procedures, with fatality rate at 12.5%, in whom one died of rupture of abdominal aortic aneurysm and another died of septic shock. Internal fistula was occurred in three patients, but sealed one month after surgery. [Conclusion] Endovascular exclusion of abdominal aortic aneurysm is safe and feasible. The indications of endovascular exclusion of aortic aneurysms and skills of interventional procedure are key factors of successful operation.