腹主动脉瘤大小对腔内隔绝术及其疗效的影响

摘要

目的 探讨腹主动脉瘤大小对腔内隔绝术及隔绝后治疗结果的影响.方法 回顾性分析1997年3月至2007年6月共429例腹主动脉瘤的临床资料,依腹主动脉瘤直径将患者分为＜55 mm组(A组,n=274)及≥55 mm组(B组,n=155).根据术前影像学资料研究两组动脉瘤大小、瘤颈长度、瘤颈直径、瘤颈扭曲程度及髂动脉是否受累等,并探讨动脉瘤大小对腔内隔绝术及治疗结果的影响.结果 A组平均年龄71.1岁,B组73.7岁(P＜0.05).B组有冠心病史者(36.1%)明显多于A组(18.6%)(P＜0.05),B组伴高血压病、糖尿病、慢性阻塞性肺疾病者多于A组,但两组间差异无统计学意义.A组腹主动脉瘤平均直径为(46.6±6.8)mm,B组为(66.8±11.2)mm(P＜0.05);B组腹主动脉瘤较A组近端瘤颈短、瘤颈直径大、瘤颈扭曲、易累及髂动脉(P＜0.05);B组患者应用腹膜外径路、髂内动脉重建或髂内动脉栓塞等附加手术、术中牵张导丝均多于A组,术中发生内漏数及使用移植物个数均高于A组(P＜0.05).围手术期并发症发生率B组高于A组,病死率无明显差异.术后B组内漏率及二次干预率均高于A组.结论 腔内隔绝术治疗腹主动脉瘤获得了较好的临床效果,而腹主动脉瘤的大小对腔内隔绝术存在一定影响,较小腹主动脉瘤无论在术中操作、围手术期并发症、术后随访等方面均优于较大腹主动脉瘤.%Objective To evaluate the effect of the diameter of abdominal aortic aneurysm(AAA)on endovascular exclusion(EVE)and its results.Methods From March 1997 to June 2007,429 AAA patients were treated with endovascular stent-graft exclusion.According to the maximal diameter of abdominal aortic aneurysm,the patients were divided into two groups:group A(diameter＜55 mm,n=274)and group B(diametert≥55 mm,n=155).The diameter of AAA,involvement of iliac artery,length,diameter and distortion of aneurismal neck in the two groups were recorded and compared retrospectively.Results Patients in group B were significantly older than group A(73.7 vs 71.1 years,P＜0.05).More patients in group B was complicated with coronary artery disease than those in group A(P＜0.05).The mean diameter of AAA in group A was(46.6±6.8)mm,and(66.8±11.2)mm in group B(P＜0.05).Proximal aneurysmal necks were shorter,wider and more tortuous in group B than those in group A(P＜0.05).Extraperitoneal approach,embolism of inner iliac artery and reconstruction of another inner iliac artery and stretch technique were more applied in group B.There were more endoleak during operation in group B and more stent-grafts were used.There was significant difference in morbility rate between the two groups,while no statistic difference in mortality.And in group B,there were a high rate of endoleak and secondary intervention post operation.Conclusions The diameter of AAA affects EVE and its results.In small aneurysms,EVE carries better outcome than in big aneurysms.