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1、分分 类类 号号 学号学号 D201078233D201078233 学校代码学校代码 10487 10487 密级密级 博士学位论文 腔内修复治疗高危复杂腹主动脉瘤的临床腔内修复治疗高危复杂腹主动脉瘤的临床应用研究应用研究 学位申请人：学位申请人： 袁袁 锋锋 学 科 专 业 ：学 科 专 业 ： 影像医学与核医学影像医学与核医学 指 导 教 师 ：指 导 教 师 ： 韩韩 萍萍 教授教授 梁惠民梁惠民 副教授副教授 答 辩 日 期 ：答 辩 日 期 ： 20132013 年年 4 4 月月 A dissertation submitted to Huazhong University of
2、 Science and Technology for the Degree of Doctor of Medicine A Clinical Application Study of Endovascular Repair treatment for High-risk and Complex Abdominal Aortic Aneurysm D.Candidate : Yuan Feng Major : Medical Imaging and Nuclear Medicine Supervisor : Prof. Han Ping Prof. Liang Huiming Huazhong
3、 University of Science 2 cases with intraoperative dissection of iliac artery, 1 case with postoperative pseudoaneurysm of femoral artery, these cases had been cured by appropriate measures. The follow-up period ranged from 2 months to 48 months, the mean time was (17.8 13.9) months, 19 cases lost f
4、ollow-up, the percentage of follow-up was 68.9%. In the follow-up period, there were 13 cases with endoleak, including 3 cases of type I and 10 cases of type II, the incidence of endoleak was 31.0%; 1 case with stent-graft migration and 2 cases with stent-graft obstruction occurred during the same p
5、eriod; 1 case had implemented second intervention operation because of aneurysm rupture. A total of 6 patients died, whose deaths were unrelated to AAA, overall survival rate was 85.7%. Conclusions: EVAR is a feasible method for the treatment of patients with high-risk and complex AAA. Detailed preo
6、perative evaluation, sufficient preoperative preparation, individual perioperative treatment, regular follow-up are necessary measures to ensure the successful treatment of patients with high-risk and complex AAA. Key words: abdominal aortic aneurysm; endovascular abdominal aortic aneurysm repair; s
7、tent-graft; complication. Part II An Analysis of Clinical Curative Effect for Endovascular Repair of High-risk and Complex Abdominal Aortic Aneurysm 华华 中中 科科 技技 大大 学学 博博 士士 学学 位位 论论 文文 6 Objective: To Evaluate the clinical curative effect by using endovascular repair for treatment of patients with h
8、igh-risk and complex AAA. Methods: Collect and collate the clinical data of 155 patients suffered AAA, who had been cured in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology between January 2009 and December 2012, divide patients into two groups: h
9、igh-risk and complex group versus ordinary group, contrast the patients of two groups in general condition, perioperative period treatment and follow-up result, and analyze the differences between these two groups. Results: There were 61 patients in high-risk and complex group versus 94 patients in
10、ordinary group. The mean age of the patients in high-risk and complex group was older than ordinary group (68.4 13.5) years (63.3 11.2) years), the percentage of the patients with pain, the mean diameter and the mean length of the aneurysms in high-risk and complex group were higher than ordinary gr
11、oup (37.7% 22.3%, (5.9 1.5) cm (4.8 1.2) cm, (9.4 2.1) cm (7.9 1.8) cm), the differences between this two groups had statistical significance (P0.05). Four patients had implemented emergency operation in high-risk and complex group, including 1 cases of death, perioperative mortality was 1.6%; there
12、 was no case of emergency operation and death in ordinary group. The number of patients with endoleak in high-risk and complex group versus ordinary group were 11 cases versus 16 cases during perioperative period, the incidence of endoleak were 18.0% versus 17.0%; the number of patients with vascula
13、r injury in these two groups were 3 cases versus 1 case during perioperative period, the incidence of vascular injury were 4.9% versus 1.1%; the mean length of hospital stay in these two groups were (6.8 6.2) days versus (5.9 4.1) days. The mean time of follow-up in high-risk and complex group versu
14、s ordinary group were (17.8 13.9) months versus (18.5 13.3) days, the percentage of follow-up were 68.9% versus 64.9%; the number of patients with endoleak in these two groups were 13 cases versus 17 cases during follow-up period, the incidence of endoleak were 31.0% versus 27.9%; the number of pati
15、ents with stent-graft obstruction in these two groups were 2 case 华华 中中 科科 技技 大大 学学 博博 士士 学学 位位 论论 文文 7 versus 0 case during follow-up period, the incidence of stent-obstruction were 4.8% versus 0%; overall survival rate in these two groups were 85.7% versus 91.8%. The results showed the differences had no statistical significance in the above aspects between these two groups, which were demonstrated by statistical analysis of these data. Conclusions: EVAR is a reliable method for the treatment of patients with high-risk and complex AAA. Compared with p
