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中国人民解放军总医院老年心血管病研究所
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
宦玮,金杰,蔡家伟,曲乐丰.慢性肾功能不全患者腹主动脉瘤腔内修复术治疗策略的可行性及疗效分析[J].中华老年多器官疾病杂志,2020,19(1):11~16
慢性肾功能不全患者腹主动脉瘤腔内修复术治疗策略的可行性及疗效分析
Feasibility and efficacy of modified endovascular aneurysm repair in patients with chronic renal insufficiency
投稿时间:2019-10-09  
DOI:10.11915/j.issn.1671-5403.2020.01.003
中文关键词:  腹主动脉瘤;腔内修复术;肾功能不全;造影剂肾病;治疗策略
英文关键词:abdominal aortic aneurysm; endovascular aneurysm repair; renal insufficiency; contrast-induced nephropathy; therapy strategy This work was supported by the Specifically Invited Professor of Oriental Scholar of Shanghai Colleges and Universities Tracking Program
基金项目:上海高校特聘教授(东方学者)跟踪计划(GZ2016008);上海市科委领军人才计划(16411966500);国家自然科学基金面上项目(81870347,81570440)
作者单位E-mail
宦玮 海军军医大学长征医院血管外科,上海 200003 qulefeng@smmu.edu.cnfeasibility 
金杰 海军军医大学长征医院血管外科,上海 200003 qulefeng@smmu.edu.cnfeasibility 
蔡家伟 海军军医大学长征医院血管外科,上海 200003 qulefeng@smmu.edu.cnfeasibility 
曲乐丰 海军军医大学长征医院血管外科,上海 200003 qulefeng@smmu.edu.cnfeasibility 
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中文摘要:
      目的 探讨慢性肾功能不全(CRI)患者的腹主动脉瘤(AAA)腔内修复术(EVAR)治疗策略的可行性和有效性。方法 对19例合并CRI的AAA患者采用针对CRI的改良EVAR治疗策略,同时选择40例肾功能正常患者采用常规手术方式作为对照组,比较2组患者在诊疗过程、治疗结果和并发症方面的差异。采用GraphPad 8.0统计软件对数据进行分析。依据数据类型分别采用t检验、χ2检验或Fisher检验对数据进行组间比较。结果 19例患者均顺利完成EVAR治疗,围术期无患者死亡。CRI患者术后血肌酐值较术前无明显升高(P=0.6109);1例(5.26%)因双侧肾动脉不全覆盖,行双侧肾动脉支架植入术;2例(10.53%)轻微Ⅱ型内漏,未干预;1例(5.26%)发生穿刺点血肿或感染;2例(10.53%)术后发热。所有患者围术期均未出现急性肾功能衰竭、急性脊髓、肢体缺血等严重并发症,2组间总并发症发生率无显著差异。术后3个月患者复查结果均提示支架形态位置良好、无内漏,AAA瘤腔内完全血栓化,各分支动脉血流通畅。随访期(2~28个月,中位15个月)内,1例患者因急性心肌梗死死亡,其余患者未发生支架移位、急(慢)性肾功能衰竭、肢体缺血等严重并发症。结论 针对CRI患者所使用的EVAR治疗策略,可有效保护肾功能,降低术后对比剂相关并发症发生率,有效扩大EVAR术的适应证范围。
英文摘要:
      Objective To investigate the feasibility and efficacy of therapeutic strategy using modified endovascular aneurysm repair (EVAR) in abdominal aortic aneurysm (AAA) patients with chronic renal insufficiency (CRI). Methods Modified EVAR was performed on AAA 19 patients with CRI, and routine EVAR on 40 cases with normal renal function (control group). The two groups were compared in surgical procedures, outcomes, and complications. GraphPad statistics 8.0 was used for statistical analysis. t test, χ2 test or Fisher exact test was performed for data comparison between 2 groups. Results Modified EVAR was successful for all the 19 patients without perioperative death. There was no significant increase of SCr in CRI patients after EVAR (P=0.6109). One patient (5.26%) underwent bilateral renal arterial stenting due to partial coverage of the renal arteries. Slight endoleak (type Ⅱ) were detected in 2 patients (10.53%) without intervention, hematoma/infection puncture site was observed in 1 patient (5.26%), and postoperative fever occurred in 2 patients (10.53%). All patients had no acute renal failure, acute spinal or limb ischemia and other serious perioperative complications. No difference was found in total complications between the two groups. Imageological examinations at 3 months of follow-up showed the stents in all CRI patients in good shape and position with no endoleak, complete thrombosis in the aortic aneurysm cavity, and patency in all branch arteries. During the follow-up period (2 to 28 months, median 15 months), none of the patients except 1 who died of acute myocardial infarction had serious complications such as stent displacement, acute/chronic renal failure or limb ischemia. Conclusion The modified EVAR could protect renal function, reduce the incidence of complication and effectively extend the indications for EVAR in AAA patients with CRI.
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