腹主动脉瘤腔内修复术两种髂内动脉封堵方法的中远期随访研究

Two Methods of Internal Iliac Artery Exclusion in Endovascular Aorta Repair: a Middle-long Term Follow-up Study

中文关键词:  腔内主动脉修复术 长期随访 髂内动脉 栓塞 缺血 支架通畅率

英文关键词:EVAR Long-term follow-up Internal iliac artery Embolization Ischemia Stent patency

中文摘要:

      目的 腔内主动脉修复术（EVAR）术中使用弹簧圈栓塞与不使用弹簧圈栓塞封堵髂内动脉后缺血并发症的中长期随访结果比较。方法 回顾性分析2006年1月至2013年12月期间接受EVAR手术并封堵髂内动脉的腹主动脉瘤患者。根据封堵髂内动脉是否使用弹簧圈栓塞将患者分为A组（不使用弹簧圈栓塞）和B组（使用弹簧圈栓塞）。随访时间为2006年6月至2014年6月。结果 研究共纳入137例患者，平均年龄71.6岁，124例为男性患者。其中A组74例，B组63例。术后30 d死亡率为0.73%（1／137）。中远期随访结果显示，A、B组均未出现盆腔及脊髓缺血症状。缺血病例均出现间歇性跛行症状9例（A组 3例，B组6例），其中下肢缺血5例（A组2例，B组3例），臀肌酸痛5例（A组1例，B组4例），臀肌皮肤坏死1例（A组0例，B组1例）。支架堵塞5例（A组1例，B组4例）。两组间缺血、支架堵塞随访结果差异均无统计学意义（P=0.301, P=0.180）。进一步分析显示，B组患者单侧栓塞和双侧栓塞虽然在随访结果上无明显差别，但双侧栓塞的患者住院时间更长(P<0.001)，甚至其中1例出现了极其严重的并发症——皮肤和臀肌的坏死。结论 在EVAR术中封堵髂内动脉时使用弹簧圈栓塞与不使用弹簧圈栓塞的缺血并发症长期随访结果上无明显差别。

英文摘要:

      Objective To compare the middle and long term results of two internal iliac artery exclusionmethods (with or without coils) in endovascular aorta repair (EVAR). Methods Clinical data of patients who underwent EVAR from January 2006 to December 2013 were analyzed retrospectively. The participants were divided into two group: coils were not used in Group A, but were used in Group B. The patients were followed up from June 2006 to June 2014. Results A total of 137 patients (74 in Group A, 63 in Group B) were included in this study, with a mean age of 71.6 years. The majority (124) of participants were men. Postoperative 30-day mortality of the participants was 0.73%. None of the participants developed pelvic and spinal ischemia. Claudication appeared in 9 patients (3 in Group A and 6 in Group B). Ischemia in lower extremity happened in 5 patients (2 in Group A and 3 in Group B).Gluteal sore was reported by 5 patients (1 in Group A and 4 in Group B). One patient from Group B developed gluteal skin necrosis. No statistical difference in ischemia and stent occlusion was found between the two groups (P=0.301, P=0.108). However, patients in Group B stayed in hospitals longer (P<0.001) than those in group A. One patient in Group B developed severe ischemic complication:skin and gluteus necrosis. Conclusion Internal iliac artery exclusions with and without coilsresult in similar middle and long term outcomes measured by ischemic complications.