胸腹主动脉瘤的外科治疗  

Surgical management of thoracoabdominal aortic aneurysm

作　　者：符伟国[1] 王玉琦[1] 陈福真[1] 徐欣[1] 郭大乔[1] 陈斌[1] 杨珏[1] 

机构地区：[1]上海医科大学附属中山医院血管外科,200032

出　　处：《中华普通外科杂志》1998年第5期278-281,共4页Chinese Journal of General Surgery

摘　　要：目的评价胸腹主动脉瘤不同的手术方式以及影响早期手术病死率的相关因素。方法回顾性总结1974～1996年胸腹主动脉瘤14例的手术体会,按 Crawford 分型,Ⅰ型2例、Ⅱ型3例、Ⅲ型5例、Ⅳ型4例。手术方式:(1)假性动脉瘤切除修补术;(2)动脉瘤旷置,分支型人造血管旁路转流,腹腔、肠系膜上和两肾动脉依次与人造血管分支端端吻合术;(3)动脉瘤切除、人造血管植入端端吻合、内脏动脉成片缝合重建术(Crawford 手术)。结果术后30天内死亡4例,晚期死亡2例,其余8例分别已存活1～12年。肾功能衰竭发生率17%,手术病死率33%。术中出血过多和动脉阻断时间延长是引起肾功能衰竭和术后早期死亡的主要因素。结论 Crawford 所倡用的手术方式是目前胸腹主动脉瘤较为理想的治疗方法。Objective To evaluate three kinds of surgical management of thoracoabdominal aortic aneurysm and identify factors causing early death in patients undergoing thoracoabdominal aortic operations.Methods Data on 14 patients who underwent thoracoabdominal aortic operations between 1974 to 1996 were retrospective reviewed.The extent of thoracoabdominal aortic aneurysm included type Ⅰ(2 cases),type Ⅱ(3 cases),type Ⅲ(5 cases),and type Ⅳ(4 cases.Procedures consisted of(1)excision of the pseudoaneurysm and repairing the aortie wall;(2)permanent by- pass graft and reattachment of visceral vessels to branches of the graft,leaving the aneurysm in place with proximal in- flow occluded;and(3)graft inclusion with direct visceral artery reattachment.Results There were 4 early(30- day)deaths and 2 late deaths;8 patients were still alive 1 to 12 years after operation.The rate of renal failure was 17% and the motality rate 33%.The major causes of renal failure and early death were intraoperative hemorrhage and long aortic clamp time.Conclusion Crawford' s procedure is still the mainstay for the treatment of thoracoabdominal aortic aneurysm because of the relative safety and simplicity.

关 键 词：主动脉瘤 胸主动脉瘤 腹主动脉瘤 外科手术 

分 类 号：R543.16[医药卫生—心血管疾病]