腹主动脉瘤腔内修复术中髂内动脉封堵后盆腔缺血症状发生的危险因素

doi:10.3785/j.issn.1008-9292.2019.10.13

浙江大学学报（医学版）

2019, Vol. 48

Issue (5): 546-551 DOI: 10.3785/j.issn.1008-9292.2019.10.13

原著

腹主动脉瘤腔内修复术中髂内动脉封堵后盆腔缺血症状发生的危险因素

麦合木提江·穆扎帕(

),周敏*(

)

南京大学医学院附属鼓楼医院血管外科, 江苏南京 210008

Risk factors of pelvic ischemic symptoms after iliac artery occlusion during endovascular aneurysm repair

Mehmutjan Muzepper(

),ZHOU Min*(

)

Department of Vascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China

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摘要：

目的: 分析腹主动脉瘤腔内修复术（EVAR）中封堵髂内动脉后发生盆腔缺血症状的危险因素。方法: 收集2014年1月—2018年6月南京大学医学院附属鼓楼医院血管外科EVAR中行单侧髂内动脉封堵的腹主动脉瘤患者82例，根据随访结果将患者分为盆腔缺血组（20例）和对照组（62例），采用单因素和多因素Logistic回归分析患者术后发生盆腔缺血的危险因素，并通过ROC曲线分析其预测髂内动脉封堵术后发生盆腔缺血症状的价值。结果: 单因素分析结果显示，盆腔缺血组和对照组封堵对侧髂内动脉分支显影数和同侧股深动脉狭窄率差异有统计学意义（均P < 0.05），随着显影分支条数增加，盆腔缺血症状的发生率下降。多因素Logistic回归分析结果显示，对侧髂内动脉分支显影数降低时发生盆腔缺血症状的危险度增加（OR=8.383，95%CI：1.469~47.841，P < 0.05）。ROC曲线分析结果显示，对侧髂内动脉分支显影数预测髂内动脉封堵后盆腔缺血症状的AUC为0.816，临界值为3.5，敏感度为0.861，特异度为0.167。结论: 术前封堵对侧髂内动脉分支显影数降低是术后发生盆腔缺血的危险因素，然而其预测特异性较低，有待积累病例研究。

关键词： 主动脉瘤, 腹/外科学; 髂动脉; 栓塞, 治疗性; 危险因素; 血管造影术; 体层摄影术, X线计算机

Abstract:

Objective: To analyze risk factors of pelvic ischemia after occlusion of the internal iliac artery during endovascular aneurysm repair (EVAR) surgery. Methods: The clinical data, preoperative CT angiography (CTA) findings and follow-up results of 82 patients with unilateral embolization of internal iliac artery undergoing EVAR were analyzed retrospectively. Among 82 patients, pelvic ischemic symptoms were developed in 20 patients (ischemia group) and the remaining patients served as control group. The risk factors for pelvic ischemia after occlusion of internal iliac artery during EVAR surgery were explored using univariate and multivariate analysis, and the clinical value was evaluated using ROC curves. Results: The univariate analysis showed that the numbers of the contralateral internal iliac artery and the ipsilateral deep femoral artery stenosis in the pelvic ischemia group were less than those in the control group (both P < 0.05). Multivariate Logistic regression analysis showed that the decreased number of internal iliac artery branches (OR=8.383, 95%CI:1.469-47.841, P < 0.05) was an independent risk of pelvic ischemia. The ROC curve analysis showed that AUC of the decreased number of contralateral internal iliac artery branches for predicting the incidence of pelvic ischemia was 0.816; when the number of 3.5 was taken as cut-off value, the corresponding sensitivity was 0.861 and the specificity was 0.167. Conclusion: The decrease in number of the contralateral internal iliac artery branches on preoperative CTA is an independent risk factor for pelvic ischemia after occlusion of the internal iliac artery during EVAR surgery, but it does not show enough clinical value.

Key words: Aortic aneurysm, abdominal/surgery Iliac artery Embolization, therapeutic Risk factors Angiography Tomography, X-ray computed

收稿日期: 2019-03-05 出版日期: 2020-01-04

R619

通讯作者: 周敏 E-mail: mf1735079@smail.nju.edu.cn;zhouminnju@126.com

作者简介: 麦合木提江·穆扎帕(1992-), 男, 硕士研究生, 住院医师, 主要从事腹主动脉瘤相关研究; E-mail:mf1735079@smail.nju.edu.cn; https://orcid.org/0000-0002-7476-5503

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引用本文:

麦合木提江·穆扎帕,周敏. 腹主动脉瘤腔内修复术中髂内动脉封堵后盆腔缺血症状发生的危险因素[J]. 浙江大学学报（医学版）, 2019, 48(5): 546-551.

Mehmutjan Muzepper,ZHOU Min. Risk factors of pelvic ischemic symptoms after iliac artery occlusion during endovascular aneurysm repair. J Zhejiang Univ (Med Sci), 2019, 48(5): 546-551.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2019.10.13 或 http://www.zjujournals.com/med/CN/Y2019/V48/I5/546

图 1 髂内动脉分型模式图

图 2 一例典型A型髂内动脉患者的分支计数方法

表 1 盆腔缺血组与对照组临床特征比较

图 3 对侧髂内动脉分支显影数预测髂内动脉封堵后发生盆腔缺血的ROC曲线

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