一体式分叉型覆膜支架治疗肾下型腹髂动脉疾病87例临床分析

刘训强; 杨春鑫; 周晓娜; 季文凯; 陈宦君; 张金辉; 张丽琼; 李翠红

doi:10.12259/j.issn.2095-610X.S20210420

一体式分叉型覆膜支架治疗肾下型腹髂动脉疾病87例临床分析

doi: 10.12259/j.issn.2095-610X.S20210420

1.
昆明医科大学附属延安医院血管介入科
2.
超声科
3.
药剂科，云南昆明　650051

基金项目: 云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目（2017FE468-090，FB085）；云南省科技厅-科技惠民专项基金资助项目（2014RA071）

详细信息

作者简介:
刘训强（1977～），男，云南昆明人，医学硕士，副主任医师，主要从事血管外科及介人科临床工作

通讯作者:
张丽琼，E-mail：zlq555888@163.com

中图分类号: R654.3
计量
- 文章访问数: 3019
- HTML全文浏览量: 1856
- PDF下载量: 13
- 被引次数: 0
出版历程
- 收稿日期: 2020-12-11
- 刊出日期: 2021-04-01

Clinical Analysis of 87 Cases of Hyporenal Abdominal Iliac Artery Disease Treated with Integrated Bifurcated Stent

1.
Dept. of Vascular Intervention
2.
Dept. of Ultrasonography
3.
Dept.of Pharmacy，Kunming Yunnan 650051，China

摘要

摘要: 目的探讨使用一体式分叉型覆膜支架腔内隔绝术治疗肾下型腹髂动脉疾病的临床经验。方法回顾性分析2015年8月至2019年10月昆明医科大学附属延安医院血管介入科使用一体式分叉型覆膜支架实施腔内隔绝术治疗肾下型腹髂动脉疾病87例的临床资料，评价其疗效。结果 87例患者均成功植入一体式分叉型覆膜支架，成功率100%。术中仅置入1个一体式分叉型覆膜支架15例，接1条腿支架36例，接2条腿支架29例，接3条腿支架4例，接4条腿支架3例。因腹髂动脉角度大、扭曲，于一体式分叉型覆膜支架髂支内置入裸支架5例，远端接裸支架3例，一体式分叉型覆膜支架上方接直筒Cuff覆膜支架1例，先行髂内动脉栓塞术14例，保留双侧髂内动脉13例，保留一侧髂内动脉51例，双侧髂内动脉均封闭23例。术后均使用球囊扩张支架两端及接头。手术时间35～122 min，平均52 min；术中出血10～50 mL，平均23 mL。87例均顺利完成手术。术后1例因肾衰竭、多器官功能衰竭自动出院后死亡，其余均好转出院。术后随访85例2～24个月，均健在，失访1例。术后3～6月复查CTA：支架形态位置良好，无内漏、移位，病变封闭良好 。结论 使用一体式分叉型覆膜支架腔内隔绝术治疗肾下型腹髂动脉疾病具有微创、疗效确切、操作简便、成功率高、缩短手术时间、安全、并发症少、术后恢复快等优势，近期、中期疗效较好，远期疗效仍有待观察。
- 一体式分叉型覆膜支架 /
- 肾下型腹髂动脉疾病 /
- 临床分析
Abstract: Objective To explore the clinical efficacy of the treatment of subrenal iliac abdominal artery disease with integrated bifurcated stent graft. Methods Retrospective analysis was performed on 87 cases of subrenal abdominal iliac artery disease treated by intracavitary isolation with unibody bifurcated stent in the Department of Vascular Interventional Surgery of Yan'an Hospital Affiliated to Kunming Medical University from August 2015 to October 2019. Results 87 patients were successfully implanted with unibody bifurcated stent, the success rate was 100%. Only one unibody bifurcated stent was implanted in 15 cases, one leg stent was inserted in 36 cases, two leg stents were inserted in 29 cases, three leg stents were inserted in 4 cases, and four leg stents were inserted in 3 cases. Due to the large angle and distorted course of the abdominal iliac artery, 5 cases were treated with a bare stent inserted into the iliac branch of the integrated bifurcated coated stent, and 3 cases were treated with a bare stent distally; One case received integrated bifurcated coated stent with straight tube CUFF coated stent above it, 14 cases underwent internal iliac artery embolization first, 13 cases retained bilateral internal iliac artery, 51 cases retained one internal iliac artery, 23 cases closed both sides of internal iliac artery. Balloon was used to expand both ends and joints of the stent after surgery. The operation time was 35 min-122 min, with an average of 52 min, blood loss during operation was 10-50 ml, with an average of 23 ml, and 87 cases successfully completed the operation. One case developed renal failure and multiple organ failure after operation, 85 cases were followed up for 2-24 months, all of them were alive, 1 case was lost. CTA was reexamined 3 to 6 months after operation: the stent was in good shape and position, without internal leakage and displacement, and the lesions were closed well. Conclusions The use of the integrated bifurcated stent graft endovascular isolation for the treatment of subrenal abdominal iliac artery disease has many advantages, such as minimal invasion, good efffect, easy operation, high success rate, short operation time, safety, less complications, quick recovery and so on. The short-term and medium-term effect is better, the long-term effect remains to be observed.
- Integrated bifurcated stent /
- Hyporenal abdominal iliac artery disease /
- Clinical analysis

HTML全文

图 1 术前

双髂总动脉瘤，右髂内动脉瘤先兆破裂。

Figure 1. Preoperative CTA

下载: 全尺寸图片幻灯片

图 2 术中影像1

EVAR后从主体侧导丝使用顺应性球囊扩张支架两端及接头处，左髂总动脉分支支架与腹主动脉成锐角。

Figure 2. Intraoperative imaging 1

下载: 全尺寸图片幻灯片

图 4 术后造影

腹髂动脉血流通畅，无内漏。

Figure 4. Postoperative image

下载: 全尺寸图片幻灯片

图 3 术中影像2

左髂总动脉起始部经导丝置入球扩裸支架加强支撑。

Figure 3. Intraoperative imaging 2

下载: 全尺寸图片幻灯片

图 5 术后3月复查CTA

腹髂动脉血流通畅，支架位置形态良好，无内漏及移位。

Figure 5. CTA 3 months after operation

下载: 全尺寸图片幻灯片

参考文献(10)

[1]	AbuRahma A F,Campbell J,Stone P A,et a1. The correlation of aortic neck length to early and late outcomes in endovascular aneurysm repair patients[J]. J Vasc Surg,2009,50(4):738-748. doi: 10.1016/j.jvs.2009.04.061
[2]	Lovegrove R E,Javid M,Magee T R,et a1. A meta—analysis of 21,178 patients undergoing open or endovascular repair of abdominal aortic aneurysm[J]. Br J Surg,2008,9(6):677-684.
[3]	韩晓峰,黄小勇,郭曦,等. 一体式分叉型覆膜支架在腹主动脉及髂动脉病变腔内治疗中的应用[J]. 中华胸心血管外科杂志,2013,11(29):653-655.
[4]	Chang G Q,Li Z L. Endovascular stent-graft placement in Stanford type B aortic dissection in China[J]. Ear J Vasc Endovasc Surg,2009,37(5):646-653.
[5]	李海辉,任为. 髂动脉瘤的诊治现状[J]. 医学信息,2016,29(12):58-60. doi: 10.3969/j.issn.1006-1959.2016.12.037
[6]	史伟浩,余波,王巍. 分叉型一体式覆膜支架腔内治疗肾下型腹主动脉瘤的疗效[J]. 中国临床医学,2012,19(4):356-359. doi: 10.3969/j.issn.1008-6358.2012.04.008
[7]	吴文辉,蒲俊舟,薛玉国,等. 一体式分叉型覆膜支架在介入治疗孤立性髂动脉瘤中的应用[J]. 心肺血管病杂志,2019,38(5):494-498. doi: 10.3969/j.issn.1007-5062.2019.05.012
[8]	张萍,刘艳杰,王效增,等. 单中心一体式分叉型覆膜支架置入治疗腹主动脉疾病疗效分析[J]. 临床军医杂志,2018,46(10):1130-1132.
[9]	柏骏,曲乐丰,职康康,等. 分叉型一体式覆膜支架在腹主动脉瘤腔内修复术中的应用[J]. 中华医学杂志,2014,94(19):1462-1465. doi: 10.3760/cma.j.issn.0376-2491.2014.19.008
[10]	Thompson M M,Heyligers J M,Hayes P D,et al. Endovascular aneurysm sealing:Early and midterm results from the EVAS FORWARD global registry[J]. J Endovasc Ther,2016,23(5):685-692. doi: 10.1177/1526602816664365

相关文章(20)

[1]	李正刚, 寸新华, 唐兴, 王国梁, 杨毅, 陈佳晖, 李彪. 组配式与一体式股骨假体联合转子下短缩截骨治疗Crowe IV型DDH的疗效比较, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20210115
[2]	陶文玉, 陈郊丽, 李奕平, 王飞英, 王晓苓, 熊煜欣, 杨莹. 内分泌科合并感染的住院患者临床分析, 昆明医科大学学报.
[3]	李明, 余化霖, 白鹏. 经翼点入路显微手术治疗前交通动脉瘤临床分析, 昆明医科大学学报.
[4]	李培凯. 云南省级某综合医院精神科联络-会诊现状及其相关因素, 昆明医科大学学报.
[5]	严晓华. 170例儿童川崎病临床分析, 昆明医科大学学报.
[6]	闫俊芳. 布鲁菌病12例临床分析, 昆明医科大学学报.
[7]	陈永生. 平片疝补片治疗股疝20例临床分析, 昆明医科大学学报.
[8]	孟丽红. 首发为神经系统症状的低血糖反应临床分析, 昆明医科大学学报.
[9]	段元元. 输卵管妊娠腹腔镜治疗后持续性输卵管妊娠的非手术治疗, 昆明医科大学学报.
[10]	张红芸. 卵巢妊娠26例临床分析, 昆明医科大学学报.
[11]	段元元. 腹腔镜治疗有生育要求的输卵管妊娠60例临床分析, 昆明医科大学学报.
[12]	. 支气管及肺动脉成形术89例中央型肺癌临床分析, 昆明医科大学学报.
[13]	. Stanford B型主动脉夹层腔内治疗中封堵左锁骨下动脉86例临床分析, 昆明医科大学学报.
[14]	. 成人过敏性紫癜32例临床分析, 昆明医科大学学报.
[15]	. 附子中毒156例临床分析, 昆明医科大学学报.
[16]	. 41例恙虫病临床分析, 昆明医科大学学报.
[17]	蔡吉芬. 附子中毒156例临床分析, 昆明医科大学学报.
[18]	. 乡镇卫生院微创经皮锁钉钢板治疗四肢骨折临床分析, 昆明医科大学学报.
[19]	. 胸乳入路腔镜下甲状腺切除术8例临床分析, 昆明医科大学学报.
[20]	. 康妇炎胶囊联合甲磺酸左氧氟沙星胶囊治疗盆腔炎性疾病144例临床分析, 昆明医科大学学报.