• 復(fù)旦大學(xué)附屬中山醫(yī)院血管外科(上海200032);

目的　探討以瘤腔內(nèi)壓力（Psac）測定手段研究內(nèi)漏的現(xiàn)況，揭示各型內(nèi)漏的特性。方法　回顧和比較以Psac測定手段研究內(nèi)漏的文獻(xiàn)。用體外模型和動(dòng)物模型模擬內(nèi)漏，或者在臨床內(nèi)漏病例中，用各種壓力傳感器測量瘤腔內(nèi)壓力。比較各項(xiàng)研究中無內(nèi)漏和各型內(nèi)漏Psac的差異。 結(jié)果　無內(nèi)漏時(shí)Psac＞0，但明顯低于系統(tǒng)壓力（Psys）。Ⅰ型和Ⅳ型內(nèi)漏的Psac接近Psys。關(guān)于Ⅱ型內(nèi)漏Psac的特點(diǎn)，目前研究結(jié)論尚存在相互矛盾之處。結(jié)論　術(shù)后Psac大幅度下降消除了瘤體破裂的風(fēng)險(xiǎn)，是腔內(nèi)治療成功的標(biāo)志。較小的Ⅰ型內(nèi)漏也可以導(dǎo)致Psac明顯升高，因此必須處理。Ⅱ型內(nèi)漏的危害性和處理原則尚存爭議，有待進(jìn)一步研究。

引用本文： 石赟,符偉國. 腹主動(dòng)脈瘤腔內(nèi)壓力測定揭示內(nèi)漏特性. 中國普外基礎(chǔ)與臨床雜志, 2006, 13(6): 671-675. doi: 復(fù)制

1. 　Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms [J]. Ann Vasc Surg， 1991; 5(6)∶491.
2. 　White GH, Yu W, May J, et al. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management [J]. J Endovasc Surg， 1997; 4(2)∶152.
3. 　Gilling-Smith G, Brennan J, Harris P, et al. Endotension after endovascular aneurysm repair: definition, classification, and strategies for surveillance and intervention [J]. J Endovasc Surg， 1999; 6(4)∶305.
4. 　White GH, May J, Petrasek P, et al. Endotension: an explanation for continued AAA growth after successful endoluminal repair [J]. J Endovasc Surg， 1999; 6(4)∶308.
5. 　Schurink GW, Aarts NJ, Wilde J， et al. Endoleakage after st-ent-graft treatment of abdominal aneurysm: implications on pressure and imaging——an in vitro study [J]. J Vasc Surg， 1998; 28(2)∶234.
6. 　Chong CK, How TV, Gilling-Smith GL, et al. Modeling endoleaks and collateral reperfusion following endovascular AAA exclusion [J]. J Endovasc Ther， 2003; 10(3)∶424.
7. 　Sanchez LA, Faries PL, Marin ML, et al. Chronic intraaneurysmal pressure measurement: an experimental method for evaluating the effectiveness of endovascular aortic aneurysm exclusion [J]. J Vasc Surg， 1997; 26(2)∶222.
8. 　Diaz S, Uzieblo MR, Desai KM, et al.Type Ⅱ endoleak in porcine model of abdominal aortic aneurysm [J]. J Vasc Surg， 2004; 40(2)∶339.
9. 　Dayal R, Mousa A, Bernheim J, et al. Characterization of retrograde collateral (type Ⅱ) endoleak using a new canine model [J]. J Vasc Surg， 2004; 40(5)∶985.
10. 　Criado E, Marston WA, Woosley JT, et al. An aortic aneurysm model for the evaluation of endovascular exclusion prostheses [J]. J Vasc Surg， 1995; 22(3)∶306.
11. 　Chuter T, Ivancev K, Malina M, et al. Aneurysm pressure following endovascular exclusion [J]. Eur J Vasc Endovasc Surg， 1997; 13(1)∶85.
12. 　Treharne GD, Loftus IM, Thompson MM, et al. Quality control during endovascular aneurysm repair: monitoring aneurysmal sac pressure and superficial femoral artery flow velocity [J]. J Endovasc Surg， 1999; 6(3)∶239.
13. 　Baum RA, Carpenter JP, Tuite CM, et al. Diagnosis and treatment of inferior mesenteric arterial endoleaks after endovascular repair of abdominal aortic aneurysms [J]. Radiology， 2000; 215(2)∶409.
14. 　Sonesson B, Dias N, Malina M, et al. Intra-aneurysm pressure measurements in successfully excluded abdominal aortic aneurysm after endovascular repair [J]. J Vasc Surg， 2003; 37(4)∶733.
15. 　Ellozy SH, Carroccio A, Lookstein RA, et al. First experience in human beings with a permanently implantable intrasac pressure transducer for monitoring endovascular repair of abdominal aortic aneurysms [J]. J Vasc Surg， 2004; 40(3)∶405.
16. 　Parodi JC, Berguer R, Ferreira LM, et al.Intra-aneurysmal pressure after incomplete endovascular exclusion [J]. J Vasc Surg， 2001; 34(5)∶909.
17. 　Chaudhuri A, Ansdell LE, Grass AJ, et al. Intrasac pressure waveforms after endovascular aneurysm repair (EVAR) are a reliable marker of type Ⅰ endoleaks, but not type Ⅱ or combined types: an experimental study [J]. Eur J Vasc Endovasc Surg， 2004; 28(4)∶373.
18. 　Xenos ES, Stevens SL, Freeman MB, et al. Distribution of sac pressure in an experimental aneurysm model after endovascular repair: the effect of endoleak types Ⅰ and Ⅱ [J].J Endovasc Ther， 2003; 10(3)∶516.
19. 　Mehta M, Veith FJ, Ohki T, et al. Significance of endotension, endoleak, and aneurysm pulsatility after endovascular repair [J]. J Vasc Surg， 2003; 37(4)∶842.
20. 　Szilagyi DE, Elliott JP, Smith RF. Clinical fate of the patient with asymptomatic abdominal aortic aneurysm and unfit for surgical treatment [J]. Arch Surg， 1972; 104(4)∶600.
21. 　Pacanowski JP, Stevens SL, Freeman MB, et al. Endotension distribution and the role of thrombus following endovascular AAA exclusion [J]. J Endovasc Ther， 2002; 9(5)∶639.
22. 　Schurink GW, van Baalen JM, Visser MJ, et al.Thrombus within an aortic aneurysm does not reduce pressure on the aneurysmal wall [J]. J Vasc Surg， 2000; 31(3)∶501.
23. 　Vallabhaneni SR, Gilling-Smith GL, Brennan JA, et al. Can intrasac pressure monitoring reliably predict failure of endovascular aneurysm repair? [J]. J Endovasc Ther， 2003; 10(3)∶524.
24. 　Englund R, Lalak N, Jacques T, et al. Sigmoid and gastric tonometry during infrarenal aortic aneurysm repair [J]. Aust N Z J Surg， 1996; 66(2)∶88.
25. 　Shigematsu H, Nunokawa M, Hatakeyama T, et al. Inferior mesenteric and hypogastric artery reconstruction to prevent colonic ischaemia following abdominal aortic aneurysmectomy [J]. Cardiovasc Surg， 1993; 1(1)∶13.
26. 　Resch T, Ivancev K, Lindh M, et al. Persistent collateral perfusion of abdominal aortic aneurysm after endovascular repair does not lead to progressive change in aneurysm diameter [J]. J Vasc Surg， 1998; 28(2)∶242.
27. 　Liewald F, Ermis C, Gorich J, et al. Influence of treatment of type Ⅱ leaks on the aneurysm surface area [J]. Eur J Vasc Endovasc Surg， 2001; 21(4)∶339.
28. 　Malina M, Ivancev K, Chuter TA, et al. Changing aneurysmal morphology after endovascular grafting: relation to leakage or persistent perfusion [J]. J Endovasc Surg， 1997； 4(1)∶23.
29. 　 Gorich J, Rilinger N, Sokiranski R, et al. Embolization of type Ⅱ endoleaks fed by the inferior mesenteric artery: using the superior mesenteric artery approach [J]. J Endovasc Ther， 2000; 7(4)∶297.
30. 　Politz JK, Newman VS, Stewart MT. Late abdominal aortic aneurysm rupture after AneuRx repair: a report of three cases [J]. J Vasc Surg， 2000; 31(3)∶599.
31. 　Zarins CK, White RA, Hodgson KJ, et al. Endoleak as a predictor of outcome after endovascular aneurysm repair: AneuRx multicenter clinical trial [J]. J Vasc Surg， 2000; 32(1)∶90.
32. 　van Marrewijk CJ, Fransen G, Laheij RJ, et al. Is a type Ⅱ endoleak after EVAR a harbinger of risk? Causes and outcome of open conversion and aneurysm rupture during follow-up [J].Eur J Vasc Endovasc Surg， 2004; 27(2)∶128.
  1. 1. 　Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms [J]. Ann Vasc Surg， 1991; 5(6)∶491.
  2. 2. 　White GH, Yu W, May J, et al. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management [J]. J Endovasc Surg， 1997; 4(2)∶152.
  3. 3. 　Gilling-Smith G, Brennan J, Harris P, et al. Endotension after endovascular aneurysm repair: definition, classification, and strategies for surveillance and intervention [J]. J Endovasc Surg， 1999; 6(4)∶305.
  4. 4. 　White GH, May J, Petrasek P, et al. Endotension: an explanation for continued AAA growth after successful endoluminal repair [J]. J Endovasc Surg， 1999; 6(4)∶308.
  5. 5. 　Schurink GW, Aarts NJ, Wilde J， et al. Endoleakage after st-ent-graft treatment of abdominal aneurysm: implications on pressure and imaging——an in vitro study [J]. J Vasc Surg， 1998; 28(2)∶234.
  6. 6. 　Chong CK, How TV, Gilling-Smith GL, et al. Modeling endoleaks and collateral reperfusion following endovascular AAA exclusion [J]. J Endovasc Ther， 2003; 10(3)∶424.
  7. 7. 　Sanchez LA, Faries PL, Marin ML, et al. Chronic intraaneurysmal pressure measurement: an experimental method for evaluating the effectiveness of endovascular aortic aneurysm exclusion [J]. J Vasc Surg， 1997; 26(2)∶222.
  8. 8. 　Diaz S, Uzieblo MR, Desai KM, et al.Type Ⅱ endoleak in porcine model of abdominal aortic aneurysm [J]. J Vasc Surg， 2004; 40(2)∶339.
  9. 9. 　Dayal R, Mousa A, Bernheim J, et al. Characterization of retrograde collateral (type Ⅱ) endoleak using a new canine model [J]. J Vasc Surg， 2004; 40(5)∶985.
  10. 10. 　Criado E, Marston WA, Woosley JT, et al. An aortic aneurysm model for the evaluation of endovascular exclusion prostheses [J]. J Vasc Surg， 1995; 22(3)∶306.
  11. 11. 　Chuter T, Ivancev K, Malina M, et al. Aneurysm pressure following endovascular exclusion [J]. Eur J Vasc Endovasc Surg， 1997; 13(1)∶85.
  12. 12. 　Treharne GD, Loftus IM, Thompson MM, et al. Quality control during endovascular aneurysm repair: monitoring aneurysmal sac pressure and superficial femoral artery flow velocity [J]. J Endovasc Surg， 1999; 6(3)∶239.
  13. 13. 　Baum RA, Carpenter JP, Tuite CM, et al. Diagnosis and treatment of inferior mesenteric arterial endoleaks after endovascular repair of abdominal aortic aneurysms [J]. Radiology， 2000; 215(2)∶409.
  14. 14. 　Sonesson B, Dias N, Malina M, et al. Intra-aneurysm pressure measurements in successfully excluded abdominal aortic aneurysm after endovascular repair [J]. J Vasc Surg， 2003; 37(4)∶733.
  15. 15. 　Ellozy SH, Carroccio A, Lookstein RA, et al. First experience in human beings with a permanently implantable intrasac pressure transducer for monitoring endovascular repair of abdominal aortic aneurysms [J]. J Vasc Surg， 2004; 40(3)∶405.
  16. 16. 　Parodi JC, Berguer R, Ferreira LM, et al.Intra-aneurysmal pressure after incomplete endovascular exclusion [J]. J Vasc Surg， 2001; 34(5)∶909.
  17. 17. 　Chaudhuri A, Ansdell LE, Grass AJ, et al. Intrasac pressure waveforms after endovascular aneurysm repair (EVAR) are a reliable marker of type Ⅰ endoleaks, but not type Ⅱ or combined types: an experimental study [J]. Eur J Vasc Endovasc Surg， 2004; 28(4)∶373.
  18. 18. 　Xenos ES, Stevens SL, Freeman MB, et al. Distribution of sac pressure in an experimental aneurysm model after endovascular repair: the effect of endoleak types Ⅰ and Ⅱ [J].J Endovasc Ther， 2003; 10(3)∶516.
  19. 19. 　Mehta M, Veith FJ, Ohki T, et al. Significance of endotension, endoleak, and aneurysm pulsatility after endovascular repair [J]. J Vasc Surg， 2003; 37(4)∶842.
  20. 20. 　Szilagyi DE, Elliott JP, Smith RF. Clinical fate of the patient with asymptomatic abdominal aortic aneurysm and unfit for surgical treatment [J]. Arch Surg， 1972; 104(4)∶600.
  21. 21. 　Pacanowski JP, Stevens SL, Freeman MB, et al. Endotension distribution and the role of thrombus following endovascular AAA exclusion [J]. J Endovasc Ther， 2002; 9(5)∶639.
  22. 22. 　Schurink GW, van Baalen JM, Visser MJ, et al.Thrombus within an aortic aneurysm does not reduce pressure on the aneurysmal wall [J]. J Vasc Surg， 2000; 31(3)∶501.
  23. 23. 　Vallabhaneni SR, Gilling-Smith GL, Brennan JA, et al. Can intrasac pressure monitoring reliably predict failure of endovascular aneurysm repair? [J]. J Endovasc Ther， 2003; 10(3)∶524.
  24. 24. 　Englund R, Lalak N, Jacques T, et al. Sigmoid and gastric tonometry during infrarenal aortic aneurysm repair [J]. Aust N Z J Surg， 1996; 66(2)∶88.
  25. 25. 　Shigematsu H, Nunokawa M, Hatakeyama T, et al. Inferior mesenteric and hypogastric artery reconstruction to prevent colonic ischaemia following abdominal aortic aneurysmectomy [J]. Cardiovasc Surg， 1993; 1(1)∶13.
  26. 26. 　Resch T, Ivancev K, Lindh M, et al. Persistent collateral perfusion of abdominal aortic aneurysm after endovascular repair does not lead to progressive change in aneurysm diameter [J]. J Vasc Surg， 1998; 28(2)∶242.
  27. 27. 　Liewald F, Ermis C, Gorich J, et al. Influence of treatment of type Ⅱ leaks on the aneurysm surface area [J]. Eur J Vasc Endovasc Surg， 2001; 21(4)∶339.
  28. 28. 　Malina M, Ivancev K, Chuter TA, et al. Changing aneurysmal morphology after endovascular grafting: relation to leakage or persistent perfusion [J]. J Endovasc Surg， 1997； 4(1)∶23.
  29. 29. 　 Gorich J, Rilinger N, Sokiranski R, et al. Embolization of type Ⅱ endoleaks fed by the inferior mesenteric artery: using the superior mesenteric artery approach [J]. J Endovasc Ther， 2000; 7(4)∶297.
  30. 30. 　Politz JK, Newman VS, Stewart MT. Late abdominal aortic aneurysm rupture after AneuRx repair: a report of three cases [J]. J Vasc Surg， 2000; 31(3)∶599.
  31. 31. 　Zarins CK, White RA, Hodgson KJ, et al. Endoleak as a predictor of outcome after endovascular aneurysm repair: AneuRx multicenter clinical trial [J]. J Vasc Surg， 2000; 32(1)∶90.
  32. 32. 　van Marrewijk CJ, Fransen G, Laheij RJ, et al. Is a type Ⅱ endoleak after EVAR a harbinger of risk? Causes and outcome of open conversion and aneurysm rupture during follow-up [J].Eur J Vasc Endovasc Surg， 2004; 27(2)∶128.