Đánh giá kết quả sớm điều trị phình động mạch chủ bụng dưới thận bằng ống ghép nội mạch

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Khánh Đức Hồ, Quang Khánh Huỳnh, Minh Tùng Lý, Minh Trung Nguyễn, Vĩnh Hưng Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2023

Mô tả vật lý: tr.129

Bộ sưu tập: Metadata

ID: 339319

Thêm vào giỏ Liên kết toàn văn

- Đặt vấn đề: Can thiệp đặt ống ghép nội mạch (EndoVascular Aneurysm Repair - EVAR) là một trong những phương pháp tối ưu điều trị phình động mạch chủ (ĐMC) bụng hiện nay. Tuy nhiên, không phải trường hợp nào cũng có thể thực hiện thuận lợi bởi cấu trúc giải phẫu ĐMC khác nhau trên từng bệnh nhân. Vì lý do đó, chúng tôi thực hiện nghiên cứu này nhằm đánh giá kết quả sớm điều trị phình ĐMC bụng dưới thận bằng ống ghép nội mạch tại bệnh viện Bình Dân. Đồng thời, phân tích một số yếu tố liên quan đến kết quả điều trị hay ảnh hưởng đến sự xuất hiện biến chứng sớm trong thời gian hậu phẫu. - Mục tiêu nghiên cứu: (1) Mô tả đặc điểm lâm sàng, đặc điểm hình ảnh học phình ĐMC bụng dưới thận. (2) Đánh giá kết quả sớm sau điều trị phình ĐMC bụng dưới thận bằng phương pháp EVAR. (3) Xác định một số yếu tố liên quan đến kết quả điều trị.- Đối tượng và phương pháp nghiên cứu: Hồi cứu, mô tả hàng loạt ca, từ tháng 08/2017 đến tháng 08/2021, tại BV Bình Dân. Tất cả bệnh nhân được chẩn đoán phình ĐMC bụng dưới thận thỏa tiêu chuẩn chọn mẫu và được điều trị bằng phương pháp EVAR.- Kết quả: 29 bệnh nhân, tuổi trung bình là 69.6 ± 10.2
nam gấp đôi nữ. Lâm sàng thường gặp: đau bụng / đau lưng (75.9%). Yếu tố nguy cơ phổ biến nhất là tăng huyết áp (93.1%). Hình dạng cổ túi phình nón ngược chiếm 69%
túi phình dạng thoi là 93.1%. Tỷ lệ thành công về mặt kỹ thuật cao đạt 100%. Rò nội mạch sau bung ống ghép đều được giải quyết tốt ngay trong lúc can thiệp. Tỷ lệ thành công về mặt lâm sàng tương đối cao (79.3%). Tử vong, biến chứng sớm thấp (3.4%). Không có sự khác biệt ý nghĩa về kết quả sớm sau EVAR giữa nhóm cổ túi phình thuận lợi và cổ không thuận lợi. Đường kính ngang cổ túi phình, hiệu số chênh lệch vùng cổ, hình dạng cổ túi phình (nón ngược), thời gian can thiệp là các yếu tố làm tăng nguy cơ xuất hiện biến chứng sớm.- Kết luận: Kết quả theo dõi sau 30 ngày cho thấy EVAR có hiệu quả tốt trong điều trị phình ĐMC bụng dưới thận
đặc biệt là bệnh nhân lớn tuổi mắc nhiều bệnh nền vì kỹ thuật ít xâm lấn, tỉ lệ tử vong thấp, hồi phục nhanh, thời gian nằm viện ngắn.Abstract- Background: EndoVascular Aneurysm Repair (EVAR) is currently one of the most effective procedures to treat the abdominal aortic aneurysm (AAA). However, it may not be effective for all cases due to the different aortic anatomical structure of each patient. Therefore, we performed this study in order to evaluate the short-term follow up results of EVAR at Binh Dan Hospital and also to determine some factors associated with the early treatment result or complications postoperatively.- The aims: Of the study include (1) describing the clinical features, imaging of infrarenal AAA before the procedure, (2) evaluating the rate of early success and complications of EVAR intervention and (3) determining some of the factors associated with the early result. - Material and Method: This is a retrospectively descriptive study. All patients were diagnosed with infrarenal AAA and received EVAR treatment at our hospital from August 2017 to August 2021.- Results: 29 patients, the mean age was 69.6 ± 10.2 years old, male - female ratio was 2:1. Typical clinical signs included abdominal or back pain (75.9%). Hypertension was the most common risk factor (93.1%). AAA with reverse conical neck shape form occupied 69%
and fusiform stood at 93.1%. All cases had been endografted successfully. Moreover, endoleaks had been recognized and addressed during the procedure. There was high clinical successful rate (79.3%). Death and early complications rate were low at 3.4%. On the other hand, there was no significant difference in early outcomes after EVAR between favorable and unfavorable aneurysm necks. Neck transverse diameter, difference value or form of neck (reverse conical shape) and time of intervention were risk factors that increased the risk of early complications.- Conclusions: After 30 days follow up, we can conclude that EVAR procedure is effective for treating the infrarenal AAA, especially, for the elderly with underlying medical conditions due to its minimal invasion, low death rate and short hospitalization. DOI: 10.59715/pntjmp.1.2.15

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