[1]王豪夫,王曰伟,李君,等.腹主动脉瘤腔内修复术22例围手术期处理回顾性总结[J].介入放射学杂志,2010,(11):858-861.
 WANG Hao-fu,WANG Yu-wei,LI Jun,et al.Perioperative management of endovascular abdominal aortic aneurysm repair[J].journal interventional radiology,2010,(11):858-861.
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腹主动脉瘤腔内修复术22例围手术期处理回顾性总结()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2010年11期
页码:
858-861
栏目:
血管介入
出版日期:
2010-11-25

文章信息/Info

Title:
Perioperative management of endovascular abdominal aortic aneurysm repair
作者:
王豪夫王曰伟李君赵宗刚戚森
266003  青岛大学医学院附属医院血管外科
Author(s):
WANG Hao-fu WANG Yu-wei LI Jun ZHAO Zong-gang QI Sen
Department of Vascular Surgery, the Affiliated Hospital of Medical College, Qingdao University, Qingdao 266003, China
关键词:
主动脉瘤 腹 主动脉瘤腔内修复术 CTA 围手术期处理
分类号:
R543.16
文献标志码:
A
摘要:
目的总结腹主动脉瘤腔内修复术(EVAR)围手术期处理的临床经验。方法回顾分析22例腹主动脉瘤患者EVAR临床经过,通过术前对主要脏器功能进行评估和保护,CTA测量近远侧瘤颈长度、直径、角度和构型,瘤体与分支动脉的关系,最低肾动脉开口至腹主动脉分叉的距离,导入途径的直径、扭曲和钙化程度。根据CTA测量结果,选择覆膜支架和手术方式。术时采用局麻20例,中转全麻1例,1例通过髂总动脉重建导入途径采用硬膜外麻醉,1例合并StanfordA型主动脉夹层,术时采用全麻。在支架释放前准确定位最低肾动脉位置,至少保留一侧通畅的髂内动脉,若双侧需要覆盖,分期覆盖或髂内动脉重建。支架植入后复查造影,有无内漏,正确判断内漏类型并进行相应处理。支架近端Ⅰ内漏2例,球囊扩张1例,植入Cuff1例;支架远端Ⅰ内漏1例,球囊扩张时,动脉破裂,行人工血管补片修补术;Ⅲ型内漏3例,球囊扩张后支架植入1例。1例合并StanfordA型主动脉夹层先行胸主动脉腔内修复术,后行EVAR。术后7~10d复查CTA,以后每年复查1次。结果EVAR手术全获成功。主要并发症为单侧髂肢扭结继发血栓形成,Fogarty导管取栓并支架植入1例;腹壁切口裂开1例,清创缝合;无手术死亡,随访6个月~5年,患者均存活。结论CTA图像质量高、测量准确,是EVAR术前评估和术后随访的金标准。EVAR是高危、高龄腹主动脉瘤患者有效的治疗方法。

参考文献/References:

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备注/Memo

备注/Memo:
收稿日期:20100607
更新日期/Last Update: 2010-11-25