腹主动脉瘤腔内修复术中封闭髂内动脉后的并发症

北京大学学报（医学版） ›› 2014, Vol. 46 ›› Issue (6): 917-919.

腹主动脉瘤腔内修复术中封闭髂内动脉后的并发症

栾景源1，李选1△，向勇2，傅军1，王昌明1，李天润1，韩金涛1

（1.北京大学第三医院介入血管外科，北京100191；2.贵州安顺市人民医院介入科，贵州安顺 561000）

出版日期:2014-12-18 发布日期:2014-12-18

Prognosis of embolization of internal iliac artery during the endovascular repair for abdominal aortic aneurysm

LUAN Jing-yuan1, LI Xuan1△, XIANG Yong2, FU Jun1, WANG Chang-ming1, LI Tian-run1, HAN Jin-tao1

(1.Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China; 2.Department of Interventional Radiology, Anshun People’s Hospital, Guizhou Anshun 561000, China)

Online:2014-12-18 Published:2014-12-18

摘要/Abstract

摘要： 目的：探讨腹主动脉瘤腔内修复术中保留髂内动脉的重要性。方法：回顾北京大学第三医院连续46例腹主动脉瘤腔内修复术，分析封闭髂内动脉的并发症及转归情况。结果：46例腔内修复术中有18例保留双侧髂内动脉，随访16例均未发生并发症。其余28例（60.9%）封闭一侧或双侧髂内动脉，其中封闭双侧7例（15.2%），封闭右侧14例（30.4%），封闭左侧7例（15.2%）；随访26例中，发生臀部疼痛12例（46.2％），排便习惯改变8例（32.0％），勃起功能障碍3例（12.0％），便血2例（8.0％）。对比封闭双侧和封闭单侧髂内动脉，臀肌疼痛的发生率分别为50.0%、45.0%，臀肌疼痛平均缓解时间分别为8.3个月、4.7个月，排便习惯改变发生率分别为33.3%、31.6%，勃起功能障碍发生率分别为33.3%、5.3%。对比封闭左侧和封闭右侧髂内动脉，臀肌疼痛的发生率分别为57.1%、38.5%，臀肌疼痛平均缓解时间分别为6.0个月、 3.7个月，排便习惯改变发生率分别为57.1%、16.7%，便血发生率分别为28.6%、0。结论：腹主动脉瘤腔内修复术中应尽量保留髂内动脉，尤其是左侧髂内动脉。

关键词: 主动脉瘤, 腹, 血管成形术, 髂动脉, 手术后并发症

Abstract: Objective：To study the importance of the internal iliac artery (IIA) during the endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Methods: Forty-six consecutive cases of AAA treated by EVAR were retrospectively analyzed. The complications after exclusion of the IIA were analyzed. Results: The bilateral IIAs were reserved in 18 cases, in which the follow-up was achieved in 16 cases and no complication was observed. The IIAs were excluded in 28 (60.9%) cases, in which the bilateral, right and left IIAs were excluded in 7 (15.2%), 14 (30.4%) and 7 (15.2%) cases respectively. The follow-up was achieved in 26 cases. Buttock claudication was observed in 12 (46.2%) cases, altered bowel habit was observed in 8 (32.0%) cases, erectile dysfunction was observed in 3 (12.0%) cases, and bloody stool was observed in 2 (8.0%) cases. Comparing the bilateral and unilateral IIA exclusions, the rates of buttock claudication were 50.0% vs. 45.0%, altered bowel habit 33.3% vs. 31.6%, and erectile dysfunction 33.3% vs. 5.3% respectively. And the average duration of buttock claudication of bilateral IIAs exclusion (8.3 months) was longer than that of unilateral exclusion (4.7 months). Moreover, comparing the left and right IIA exclusions, the rates of buttock claudication were 57.1% vs. 38.5%, altered bowel habit 57.1% vs. 16.7%, and bloody stool 28.6% vs. 0 respectively. And the average duration of buttock claudication of left IIA exclusion (6.0 months) was longer than that of right exclusion (3.7 months). Conclusion: The IIAs, especially the left IIA, should be reserved during the EVAR for AAA.

Key words: Aortic aneurysm, abdominal, Angioplasty, Iliac artery, Postoperative complications

栾景源, 李选, 向勇, 傅军, 王昌明, 李天润, 韩金涛. 腹主动脉瘤腔内修复术中封闭髂内动脉后的并发症[J]. 北京大学学报（医学版）, 2014, 46(6): 917-919.

LUAN Jing-Yuan, LI Xuan, XIANG Yong, FU Jun, WANG Chang-Ming, LI Tian-Run, HAN Jin-Tao. Prognosis of embolization of internal iliac artery during the endovascular repair for abdominal aortic aneurysm[J]. Journal of Peking University(Health Sciences), 2014, 46(6): 917-919.

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