摘要目的 探讨腹主动脉瘤腔内修复术后常见并发症的预防和处理方法.方法 回顾性分析复旦大学附属中山医院2003年1月至2010年12月完成的344例肾下腹主动脉瘤腔内修复术的并发症及处理情况,其中男性302例,女性42例,年龄(69±8)岁.患者术后3个月、6个月、1年,以及其后每年行腹部X线片、螺旋CT血管造影复查.结果 即刻技术成功率99.7％ (343/344),择期手术病死率0.3％ (1/334),急诊及限期手术病死率1/10.随访率81.8％(279/341),随访3～84个月,平均32.9个月.随访期间病死率1.1％( 3/279),再次手术率10.4％ (29/279);总并发症发生率12.9％ (36/279),包括内漏5.7％(16/279),支架移位1.1％ (3/279),动脉瘤增大或破裂5.4％(15/279),支架内闭塞2.5％ (7/279),移植物感染1.4％(4/279).结论 与传统手术相比,腹主动脉瘤腔内修复术的微创优势突出,而术前评估是腔内治疗取得成功的首要因素.内漏是术后远期并发症的主要类型,且为再次手术的重要原因,影响患者的远期疗效,因此术后终身随访是治疗不可缺少的一部分.

abstractsObjective To review the prevention and treatment strategies in the complications after endovascular repair (EVAR) of abdominal aortic aneurysms,retrospectively in a single medical center.Methods From January 2003 to December 2010,clinical data of 344 EVAR cases were analyzed retrospectively,including postoperative period and long-term results.There were 302 male and 42 female patients,with a mean age of (69±8) years.Patients were followed up at 3 months,6 months,and then every year with abdominal x-ray and spiral CT angiography.Results The surgical success rate was 99.7％ (343/344).The mortality with elective and emergency surgery was 0.30％ (1/334) and 1/10 respectively.The average follow-up time was 3 to 84 months with a mean of 32.9 months.The follow-up rate was 81.8％ (279/341).The mortality was 1.1％ ( 3/279),the re-intervention rate was 10.4％ (29/279) and the overall complication rate was 12.9％ ( 36/279 ),including endoleak 5.7％ ( 16/279 ),stent-graft migration 1.1％ (3/279),aneurysm expansion or rupture 5.4％( 15/279),limb occlusion 2.5％ (7/279) and stentgraft infection 1.4％ (4/279).Conclusion EVAR has allowed a minimally invasive approach to aortic pathology.A careful preoperative assessment is the key for EVAR.Endoleak continues to be the major longterm complication of the endoluminal grafting technique,and the major cause for re-intervention.Life-long follow-up is an integral part of EVAR.