肾下主动脉夹层动脉瘤的手术治疗  

Surgical treatment of the infra-renal aortic dissection aneurysm

作　　者：王利新[1] 符伟国[1] 郭大乔[1] 徐欣[1] 陈斌[1] 蒋俊豪[1] 杨珏[1] 史振宇[1] 竺挺[1] 董智慧[1] 石赟[1] 唐骁[1] 王玉琦[1] 

机构地区：[1]复旦大学附属中山医院血管外科研究所,上海200032

出　　处：《中国实用外科杂志》2009年第11期910-912,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨肾下主动脉夹层动脉瘤(IRADA)手术治疗的方式和疗效。方法回顾性分析复旦大学附属中山医院血管外科2004年1月至2009年7月治疗15例肾下主动脉夹层动脉瘤的临床资料。病人术前均通过CT血管造影(CTA)或MRA检查明确诊断。其中2例采用夹层动脉瘤切除加人工血管置换术(手术组),7例接受腔内修复术(腔内组),6例病人应用腔内修复结合传统手术治疗(杂交组)。病人术后1、3、6个月及每年于门诊进行随访。结果手术组:2例手术时间分别为3.6h和2.8h,术中失血分别为500mL和800mL,围手术期无严重并发症发生。2例病人分别随访1个月和2年,CTA示人工血管形态良好。腔内组:平均手术时间为(1.6±0.5)h,术中失血(30±20)mL。平均随访时间为(32±18)个月,6例病人随访结果满意,1例病人于6个月随访时存在少量内漏。杂交组:手术平均时间为(0.4±0.8)h,术中失血(80±30)mL,平均随访(38±16)个月,1例病人48个月时CTA发现股股人工血管吻合口中度狭窄,其余5例病人随访结果满意。结论腔内修复术和以腔内修复术为主的杂交法能有效治疗IRADA,与传统手术相比,创伤小、手术时间短,恢复快。Objective To analyze the treatment method choice and efficacy of infra-renal aortic dissection aneurysm （IRADA）. Methods The medical records of all patients with IRADA （n= 15） who were treated from January 2004 to July 2009 at Zhongshan Hospital of Fudan University were reviewed retrospectively. The diagnosis was confirmed by CTA or MRA preoperation. Of them, two patients were treated by open surgery with graft replacement （traditional surgery group, TSG）; seven patients received endovascular theapy （endovascular therapy group, ETG）; six patients were given endovascular therapy combined with open surgery （hybrid treatment group, HTG）. The patients were followed up in the 1st, 3rd, 6th month, 1 year later and every 1 year mostly with CTA. Results TSG： The operation time was 3.6h and 2.8h respectively. The blood loss volume was 500mL and 800mL. The two patients were followed up for 1 month and 24 months. CTA check showed that the configuration was satisfied. ETG： The mean operation time was （1.6± 0.5）h. The mean blood loss volume was （30±20） mL. The mean follow time was （32± 18）months. Minor endoleak was found in one patient in 6 month. No complication was detected in other patients. HTG： The mean operation time was（2.4_＋0.8）h. The mean blood loss volume was （80＋30）mL. The mean follow time was （38＋ 16）months. Moderate anastomosis stenosis of femoral to femoral bapass was observed. Conclusion IRADA could be treated by endovascular therapy and hybrid method effectively. They are less invasive, less operations time needed and recover sooner than TSG.

关 键 词：肾下主动脉夹层 腔内治疗 支架型人工血管 

分 类 号：R6[医药卫生—外科学]