腹主動(dòng)脈瘤腔內(nèi)修復(fù)術(shù)22例圍手術(shù)期處理回顧性總結(jié)

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1、腹主動(dòng)脈瘤腔內(nèi)修復(fù)術(shù)22例圍手術(shù)期處理回顧性總結(jié).-.——858..-——介入放射學(xué)雜志2010年11月第19卷第1】期JInter~rentRadiol2010,Vo1.19,No.11?血管介入Vascularintervention?腹主動(dòng)脈瘤腔內(nèi)修復(fù)術(shù)22例圍手術(shù)期處理回顧性總結(jié)王豪夫,王日偉,李君,趙宗剛,戚森【摘要J目的總結(jié)腹主動(dòng)脈瘤腔內(nèi)修復(fù)術(shù)(EVAR)圍手術(shù)期處理的臨床經(jīng)驗(yàn).方法回顧分析22例腹主動(dòng)脈瘤患者EVAR臨床經(jīng)過(guò),通過(guò)術(shù)前對(duì)主要臟器功能進(jìn)行評(píng)估和保護(hù),CTA測(cè)量近遠(yuǎn)側(cè)瘤頸長(zhǎng)度,商徑,角度和構(gòu)型,瘤體與分支動(dòng)脈的關(guān)系,最低腎動(dòng)脈開口至腹主動(dòng)

2、脈分叉的距離,導(dǎo)入途徑的直徑,扭曲和鈣化程度.根據(jù)CTA測(cè)量結(jié)果,選擇覆膜支架和手術(shù)方式.術(shù)時(shí)采用局麻20例,中轉(zhuǎn)全麻1例,1例通過(guò)髂總動(dòng)脈重建導(dǎo)入途徑采用硬膜外麻醉,1例合并StanfordA型主動(dòng)脈夾層,術(shù)時(shí)采用全麻.在支架釋放前準(zhǔn)確定位最低腎動(dòng)脈位置,至少保留一側(cè)通暢的髂內(nèi)動(dòng)脈,若雙側(cè)需要覆蓋,分期覆蓋或髂內(nèi)動(dòng)脈重建.支架植入后復(fù)查造影,有無(wú)內(nèi)漏,正確判斷內(nèi)漏類型并進(jìn)行相應(yīng)處理.支架近端I內(nèi)漏2例,球囊擴(kuò)張l例,植人Cuff1例;支架遠(yuǎn)端I內(nèi)漏l例,球囊擴(kuò)張時(shí),動(dòng)脈破裂,行人工血管補(bǔ)片修補(bǔ)術(shù);Ⅲ型內(nèi)漏3例,球囊擴(kuò)張后支架植入1例.1例合并StanfordA型

3、主動(dòng)脈夾層先行胸主動(dòng)脈腔內(nèi)修復(fù)術(shù),后行EVAR.術(shù)后7—10d復(fù)查CTA,以后每年復(fù)查1次.結(jié)果EVAR手術(shù)全獲成功.主要并發(fā)癥為單側(cè)髂肢扭結(jié)繼發(fā)血栓形成,Fogarty導(dǎo)管取栓并支架植入1例;腹壁切口裂開1例,清創(chuàng)縫合;無(wú)手術(shù)死亡,隨訪6個(gè)月一5年,患者均存活.結(jié)論CTA圖像質(zhì)量高,測(cè)量準(zhǔn)確,是EVAR術(shù)前評(píng)估和術(shù)后隨訪的金標(biāo)準(zhǔn).EVAR是高危,高齡腹主動(dòng)脈瘤患者有效的治療方法.【關(guān)鍵詞】主動(dòng)脈瘤,腹;主動(dòng)脈瘤腔內(nèi)修復(fù)術(shù);CTA;圍手術(shù)期處理中圖分類號(hào):R543.16文獻(xiàn)標(biāo)志碼:A文章編號(hào):1(x】8—794X(2010)一11-0858—04Periopera

4、tivemanagementofendovascularabdominalaorticaneurysmrepairWANG∞,WANGYu—wei,LIJun,ZHA0Zong-gang,QISen.DepartmentofVtL~cularSurgery,theAffili~edHospittdofMedic(dCollege,Qing&~,University,Qingdao266003,ChinaCorrespondingauthor:WANGHcu~-fu,E—mail:wanghf2003@126.com【Abstract】0bjectiveTo

5、summarizetheclinicalexperienceofperioperativemanagementinperformingendovascularabdominalaorticaneurysmrepair(EVAR).MethodsEVARwasperformedin22patientswithabdominalaorticaneurysm.Theclinicaldatawereretrospectivelyanalyzed.Beforetreatmentthefunctionsofmainorganswereevaluatedandcertainme

6、asureswereadoptedinordertoprotectthem.Usefulparameters,includingthelength,diameter,angleandconfigurationoftheproximalanddistalaneurysmalneck,therelationshipoftheaneurysmtoaorticbranches,thedistancefromthelowestrenalarterytothebifurcationofabdominalaorta,andthequalityofaccessvessels(su

7、chasdiameter,tortuosityandcalcificationdegree)weredeterminedandassessedwithCTA.Accordingtotheparametersthusobtained,thesuitablestent—graftwithidealdiameterandlengthwasselected,andtheoptimalsurgerypatternwasemployed.Localanesthesiawasemployedin20patients,amongthemthelocalanesthesiahadt

8、obech