腹主动脉瘤腔内隔绝术后缺血性结肠炎的诊治  

DIAGNOSIS AND MANAGEMENT OF COLONIC ISCHEMIA AFTER ENDOVASCULAR GRAFT EXCLUSION FOR ABDOMINAL AORTIC ANEURYSM

作　　者：冯翔[1] 景在平[1] 

机构地区：[1]第二军医大学长海医院,上海200433

出　　处：《解放军医学杂志》2001年第9期657-658,共2页Medical Journal of Chinese People's Liberation Army

基　　金：上海市卫生系统百人计划基金 (编号 97BR0 47);上海长海医院学科攀登计划基金资助课题

摘　　要：为探讨腹主动脉瘤术后并发缺血性结肠炎的诊断和治疗 ,作者回顾性分析了 1997年 3月～ 2 0 0 0年1月间施行的腹主动脉瘤腔内隔绝术 40例 ,其中 30例保留双侧髂内动脉 (双侧组 ) ,10例保留单侧髂内动脉或移植物远端固定于双侧髂外动脉、手术重建单侧髂内动脉 (单侧组 )。统计两组患者的术后肠蠕动恢复时间及肠道并发症。两组患者中仅双侧组 1例于术后第 2 8天始出现持续性中下腹隐痛 ,经纤维结肠镜检查确诊为缺血性结肠炎 ,经CTA发现术后继发双侧髂内动脉闭塞 ,经扩血管、促进侧支循环建立等保守治疗缓解 ;其余患者除并发其他并发症的 3例外 ,均于术后第二天恢复普食及排气排便。提示腔内隔绝术中保留单侧髂内动脉可避免术后缺血性结肠炎的发生 ;继发于术后双侧髂内动脉阻塞的慢性缺血性结肠炎 。Colonic ischemia is a well documented complication of abdominal aortic reconstruction. In this retrospective study of abdominal aortic aneurysm patients undergone endovascular graft exclusion, the incidence and management of this complication were investigated. From Mar 1997 to Apr 2000,among the 40 patients who received elective endovascular graft exclusion for,infrarenal abdominal aortic aneurysm the bilateral hypogastric artery was retained in 30 patients, the unilateral hyogastric artery was retained in 10 patients. One patient had lower abdominal pain on the 28th day after operation, CTA showed the bilateral hypogastric artery occlusion, the symptoms were relieved after drug treatment. Retaining unilateral hypogastric artery can prevent the colonic ischemia after endovascular graft exclusion for abdominal aortic aneurysm, the chronic colonic ischemia secondary to bilateral hypogastric artery occlusion can be relieved by effective drug treatment.

关 键 词：缺血性结肠炎 腹主动脉瘤 腔内隔绝术 手术后 

分 类 号：R543.16[医药卫生—心血管疾病] R656.9[医药卫生—内科学]