主动脉腔内隔绝术并发症的处理

目的 探讨主动脉腔内隔绝术(EVGE)的并发症及其发生原因和防治措施.方法 回顾性分析2002年1月至2008年10月实施主动脉腔内隔绝术的82例患者临床资料,其中男性71例,女性11例,年龄33～78岁,平均年龄49.2岁.主动脉央层66例,腹主动脉瘤16例.探讨其治疗效果、并发症及处理方法.结果 随访3～78个月,随访率90.1%.技术成功率90.3%,临床成功率94.1%.围手术期病死率2.4%,总病死率6.1%,与EVGE相关的病死率2.4%.共21例发生并发症,其中Ⅰ型内漏13例,腹主动脉十二指肠瘘1例,术后真腔狭窄2例,逆向撕裂为stanford A型夹层2例,腔内隔绝术后综合征12例,腹股沟切口愈合延迟5例,便秘3例,脑梗死1例.无截瘫、左锁骨下动脉缺血、造影剂肾病、缺血性结肠炎、神经缺血性损伤和动脉栓塞发生.二次手术4例,包括Ⅰ型内漏2例,术后真腔狭窄2例.结论 并发症是影响EVGE中远期疗效的重要因素,需要我们进一步提高防治技术和规范处理方法.

Treatment on post-operational complications of aortic endovascular grafting exclusion

Objective To investigate the pest-operative complications of aortic endovascular grafting exclusion (EVGE) and its reasons and treatments. Methods Clinical data of 82 cases received aortic endovascular grafting exclusion from January 2002 to October 2008 were retrospectively analyzed. Seventy-one cases were male and 11 cases were female with the age of 33 to 78 years and the average age of 49. 2 years. There were 66 cases of thoracic aortic dissecting aneurysms and 16 cases of abdominal aortic aneurysm. The effect, post-operational complications and its treatment were investigated. Results There were 90.1% patients had been followed up with the time of 3 to 78 months with technical success of 90. 3%, clinical success of 94. 1%, peri-operational mortality of 2. 4%, total mortality of 6. 1% and mortality associated with EVGE of 2.4%. Twenty-one cases underwent complications including type Ⅰ endoleak (13 cases), abdominalaortoduodenal fistula (1 case) , narrow true lumen (2 cases), reverse Stanford A dissection (2 cases), post EVGE syndrome (12 cases), delayed healing of inguinal incision (5 cases), constipation (3 cases), cerebral infarction (1 case). No paraplegia, left subclavian artery ischemia, contrast media associated nephrosis, ischemic colitis, ischemic neurologic injury, and artery embolism occurred. Post operation 4 cases had the second intervention including 2 type Ⅰ endoleak and 2 narrow true lumen. Conclusions The technique-related complications still hinder the long-term effect of EVGE. It needs to be further investigated on technique improvement and treatment standardization.