腹主动脉瘤破裂的外科治疗:附12例报告  

Surgical management for ruptured abdomnial aortic aneurysm:a report of twelve cases

作　　者：邹君杰[1] 章希炜[1] 孙蓬[1] 董剑[1] 陈国玉[1] 

机构地区：[1]南京医科大学第一附属医院血管外科,江苏南京210029

出　　处：《中国普通外科杂志》2007年第6期519-522,共4页China Journal of General Surgery

摘　　要：目的探讨腹主动脉瘤破裂(RAAA)的诊断和治疗方法。方法回顾分析7年间收治的1 2例腹主动脉瘤破裂者的临床资料。主要临床表现有:腹痛和/或腰背痛,血压下降或休克,腹部可触及搏动性肿块。所有患者经CT检查确诊,7例患者采用传统开腹性手术,1例行腔内支架型人工血管植入术,另外4例未行手术治疗。结果8例手术治疗者围手术期病死率为6 2.5%(5例)。死亡原因:循环衰竭2例,急性肾衰竭1例,多器官功能障碍综合征2例。未手术4例全部死亡。结论破裂腹主动脉瘤外科手术治疗病死率高。早期诊断,适当复苏,紧急外科手术,缩短手术时间,肾动脉下方阻断,是降低病死率的关键。腔内修复治疗是降低病死率的有效途径。Objective To explore the diagnosis and management of ruptured abdominal aortic aneurysm （ RAAA ）. Methods Twelve patients with RAAA treated in past 7 years were revienled retrospectively. The main clinical manifestations were abdominal pain and / or back pain, low blood pressure or shock, and pulsating abdominal mass. All cases were accurately diagnosed with CT and 7 were treated by conventional operation, one by EVAR, and the other 4 did not receive surgical treatment. Results Perioperative death occurred in 5 cases （ mortality rate was 62.5% ） in 8 surgical treated patients, including circulatory failure in 2 cases, renal failure in 1 case, and multiple organ failure in 2 cases. All the 4 patients treated with nonoperative method were dead. Conclusions Surgical operation in RAAA eases still carried a high mortality. Early dignosis, appropriate resuscitation, urgent surgical repair, reduction of operative time, and infrarenal clamping are measures conducive to lowering the mortality rate of RAAA. EVAR has the potential to reduce the mortality rate from RAAA.

关 键 词：主动脉瘤 腹/外科学 动脉瘤 破裂/治疗 血管成形术 人工血管 

分 类 号：R654.31[医药卫生—外科学]