【摘要】 目的:总结应用腔内修复术治疗腹主动脉瘤的经验,探讨内漏的防治策略。方法:回顾性分析齐鲁医院及莱钢医院2007年1月—2012年12月接受腔内治疗的43例肾下型腹主动脉瘤患者临床资料,分析内漏的发生原因、预防和处理。结果:术后发生原发性内漏11例,其中Ⅰ型8例,Ⅲ型2例;植入分叉型支架发生9例,植入直管型支架发生2例。1例Ⅱ型因漏血量小未处理;经一期经过球囊扩张、植入支架型血管或裸支架等处理后,除2例Ⅰ型内漏仍有残留,其余Ⅰ,Ⅲ型内漏均消失。39例患者获随访4~50个月,发现迟发性Ⅰb型、Ⅱ型内漏各2例,继续随访1~2年,未见瘤体明显增大。3例残留原发性内漏自愈,术后半年复发Ⅰa型内漏1例,导致动脉瘤复发破裂而再次接受腔内治疗。结论:内漏的发生与动脉瘤的解剖学条件、移植物缺陷和操作技术有关;防治内漏需要把握好手术适应证、合理选择支架,并有成熟的操作经验。更多还原

【Abstract】 Objective: To investigate the prevention and treatment of endoleak by summarizing our experience of endovascular aneurysm repair.Methods: he clinical data of 43 patients with infrarenal abdominal aortic aneurysm undergoing endovascular repair(EVAR) from January 2007 to December 2012 in Qilu Hospital and Laiwu-Steel Company Hospital were analyzed retrospectively.he causes,prevention and treatment of endoleak were analyzed.Results: Pimary endoleak ater intervention occurred in 11 patients,of whom,8 cases were type Ⅰ,1 case was type Ⅱ,and 2 cases were type Ⅲ; 9 cases underwent bifurcated stent-grat implantation and 2 cases underwent tubular stent-grat implantation.he one type Ⅱ endoleak was not treated because the leak was small; ater first-stage balloon dilatation or stent-graft implantation 2 cases of type Ⅰ endoleaks still existed,but all the other type Ⅰ and Ⅲ endoleaks were resolved.hirty-nine patients were followed up.During the period of 4 to 50 months of follow-up,2 delayed type Ⅰb and 2 delayed type Ⅱ endoleaks were found,but the aneurysms did not enlarge during the following 1- to 2-year follow-up period.he residual primary endoleak in 3 cases spontaneously disappeared,but type Ⅰa endoleak recurred in 1 case 6 months ater operation,which caused the aneurysm recurrence and rupture and a second endovascular repair.Conclusion: The occurrence of endoleak is related to anatomic condition,stent defects and surgical skill.Prevention and treatment of endoleaks require a good grasp of surgical indications,reasonable choice of stent,and mature operating experience.更多还原