中国普外基础与临床杂志

中国普外基础与临床杂志

多种介入方法治疗内脏动脉瘤 32 例经验

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目的 探讨介入治疗内脏动脉瘤的方法和疗效。 方法 回顾性分析 2011 年 2 月至 2018 年 4 月期间解放军第 960 医院收治的 32 例内脏动脉瘤患者的临床资料,介入治疗前均经 CT 或 DSA 明确诊断,然后分别采用覆膜支架置入、裸支架联合弹簧圈栓塞、双层裸支架重叠置入或单独弹簧圈栓塞治疗,置入支架的患者给予抗凝治疗,分别于术后 1、6、12 及 24 个月或患者不适时行 CTA 检查以了解动脉瘤的闭塞情况、支架及分支动脉是否通畅。 结果 本组病例的介入手术成功率 100%。11 例患者采用覆膜支架置入后造影显示动脉瘤未再显影,支架内血流通畅;9 例采用裸支架联合弹簧圈栓塞及 3 例采用双层裸支架重叠置入术后造影示动脉瘤未再显影或显影浅淡,支架内血流通畅,分支动脉血流通畅;9 例行单独弹簧圈栓塞后动脉瘤未显影。所有患者无围手术期死亡及介入手术相关并发症发生。32 例患者无失访,随访 6~48 个月,中位随访时间 25.5 个月。随访 1 个月时 1 例患者出现轻微腹痛,给予对症治疗后症状消失。随访 12 个月时 1 例覆膜支架置入者支架内狭窄<30%,患者无明显临床症状,其余患者动脉瘤未复发,支架及分支动脉内血流通畅。 结论 腔内介入治疗内脏动脉瘤是一种安全、有效的方法,近中期效果较理想。

Objective To investigate treatment methods and effect of endovascular interventional therapy for visceral artery aneurysms. Methods The clinical data of 32 patients with visceral artery aneurysms, who were treated in this hospital from February 2011 to April 2018, were retrospectively analyzed. It was proveded by the CT or DSA before the interventional therapy. The implantation of covered stent, coil embolization together with stent implantation, double stents placement or pure coil embolization were performed. The postoperative antithrombotic therapy was adopted in the patients accepted the stent implantation. The CT angiography was performed on the month of 1, 6, 12, 24 or the patient was uncomfortable after the treatment to evaluate the obstruction condition of the aneurysms, stent blood flow, and branches arteries, etc.. Results The success rate of the endovascular interventional therapy was 100%. In the 11 patients underwent the implantation of covered stent, the postoperative angiography showed that the stent lumen was patent and the aneurysm was not more visualized. In the 9 patients underwent the coil embolization together with stent implantation and 3 patients underwent the double stents placement, the postoperative angiography results of the aneurysm showed that it was faintly visualized and the branch arteries were not involved. In the 9 patients underwent the pure coil embolization, the postoperative angiography showed that the aneurysm was not more visualized. No perioperative mortality or procedure related complications occurred. No case was lost during the follow-up of a median period of 25.5 (6–48) months. During the follow-up, one patient developed the mild abdominal pain in one month, which disappeared after the symptomatic medication management. Except for 1 patient developed the mild in-stent stenosis (<30%) on the 12th months after the procedure, the stent and the branch arteries of the other patients were completely patent, and no aneurysms recurred. Conclusion For treatment of visceral artery aneurysms, endovascular interventional therapy is safe and effective and shows an excellent short-term and mid-term effect.

关键词: 内脏动脉瘤; 介入性; 裸支架; 覆膜支架; 弹簧圈

Key words: visceral artery aneurysm; interventional; bare stent; covered stent; coil

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