肾下腹主动脉瘤的治疗  

SURGICAL TREATMENT OF INFRARENAL ABODOMINAL AORTIC ANEURYSMS

作　　者：谷涌泉[1] 汪忠镐[1] 张建[1] 齐立行[1] 俞恒锡[1] 李建新[1] 郭连瑞[1] 罗涛[1] 崔世军[1] 陈兵[1] 杨盛家[1] 吴英锋[1] 董宗俊[1] 

机构地区：[1]首都医科大学宣武医院血管外科血管外科研究所,北京100053

出　　处：《中国修复重建外科杂志》2005年第12期1012-1014,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨腹主动脉瘤手术的外科及腔内介入治疗方法,以提高其安全性. 方法回顾性分析1981年1月～2004年12月收治的肾下腹主动脉瘤患者195例,其中男155例,女40例.年龄35～80岁,平均56.5岁.瘤体直径>5 cm 者183例,4～5 cm者12例.动脉瘤破裂行急诊手术者20例;择期手术175例,其中行开腹动脉瘤切除及人工血管置换术139例,行血管腔内修复术36例. 结果择期手术和急诊手术于术后30 d内分别死亡6例;余均获随访1个月～21年,平均8.7年,死亡16例,与血管手术有关的5例.腔内修复术中无手术死亡病例.发生内漏8例,其中Ⅰ型5例,Ⅱ型3例;6个月后CT检查:自行愈合6例,未愈合2例,但动脉瘤腔增大.迟发内漏1例,为Ⅱ型内漏,行介入栓塞后愈合. 结论随着血管外科手术技术的不断改进和血管腔内修复技术的开展,腹主动脉瘤手术的安全性将会不断提高.Objective To explore the method of surgical treatment and endoluminal repairs of infrarenal abdominal aortic aneurysm （AAA）so as to improve the safety of surgical treatment. Methods The information of surgical treatment was analysed restrospectively in 195 cases of infrarenal AAA treated from January 1981 to December 2004. Of the patients, 155 were males, 40 were females with a mean age of 56.5 years. The diameters of the aneurysm were larger than 5 cm in 183 patients （93.8%） and 4 to 5 cm in 12 patients （6.2%）. Of the 175 patients who underwent selective operation, graft replacements were performed in 139 and endovascular aneurysmal repairs in 36. Twenty patients （10.3%） suffering from aneurysm rupture were given emergency operation. Results There were 6 deaths in the patients underding selective operation（6/175. 4. 3%） and in those undergoing emergengcy surgery （6/20, 30%） respectively within 30 days. The other patients were followed up from 1 month to 21 years （ 8.7 years on average）, and there were 16 deaths （8. 9%） during the follow-up. No death was found in the endoluminal repaired group. Endoleak occurred in 8 patients, including 5 cases of type Ⅰ and 3 cases of type Ⅱ . After 6 months, CT scan showed that endoleak disappeared in 6 and rernained in 2. Late type Ⅱ endoleak occurred in 1 and endoleak disappeared after endoluminal embolization. Conclusion With improvement of vascular surgical technique and development of endogafting, the safety of AAA both on surgical and interventional means would be improved.

关 键 词：肾下腹主动脉瘤 人工血管置换 腔内修复 外科治疗 

分 类 号：R654.3[医药卫生—外科学]