腹主动脉假性动脉瘤诊疗研究进展  

Research progress on diagnosis and treatment of the abdominal aortic pseudoaneurysm

作　　者：车路阳 郭伟 CHE Lu-yang;GUO Wei(Department of Vascular Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100039,China;Department of Vascular Surgery,Hainan Hospital,Chinese PLA General Hospital,Sanya 572022,China)

机构地区：[1]中国人民解放军总医院第一医学中心血管外科,北京100039 [2]中国人民解放军总医院海南医院血管外科,海南三亚572022

出　　处：《中国实用外科杂志》2024年第12期1424-1429,共6页Chinese Journal of Practical Surgery

基　　金：国家重点研发计划项目(No.2020YFC1107700);国家自然科学基金面上项目(No.82170494)。

摘　　要：腹主动脉假性动脉瘤(AAPS)是一种具有较高破裂致死率的腹主动脉疾病。其病因复杂,包括感染性、免疫性、医源性、创伤性及消化性因素。AAPS的关键特征为动脉壁全层破裂,形成瘤体,病理特征是瘤壁缺乏正常动脉三层结构。感染性AAPS较罕见,占比约1%,致病菌包括金黄色葡萄球菌和结核杆菌等;非感染性AAPS中,免疫相关性AAPS与大动脉炎或白塞病相关,医源性AAPS多因腔内或开放手术操作损伤引起,创伤性和消化性AAPS则分别由外伤及消化酶侵蚀造成。AAPS的诊断主要依赖影像学方法。超声可观察典型“阴阳征”血流信号,CT血管造影(CTA)是诊断及评估病变范围的首选方法,MRA可在部分情况下提供补充信息。不同类型的AAPS在诊断中需特别关注病因及临床表现,例如感染性AAPS伴脓毒症,消化性AAPS常因消化道穿孔或胰腺炎并发。AAPS因易破裂及高死亡率需及时干预。手术为主要治疗手段,选择包括开放手术、腔内修复术及杂交手术。感染性AAPS治疗强调广谱抗生素联合清创和血流重建,非感染性AAPS则更多应用腔内修复术。开放手术适用于复杂病变或腔内治疗禁忌的病例,而杂交手术结合了腔内和开放技术的优势。AAPS因病例少,缺乏高水平证据,治疗策略需个体化。未来抗感染材料、多分支支架及3D打印技术的应用将进一步提升AAPS诊治效果。Abdominal aortic pseudoaneurysm(AAPS) is a rare abdominal aortic disease associated with a high risk of rupture and mortality.The etiology of AAPS is complex and includes infectious,immune-mediated,iatrogenic,traumatic,and digestive factors.The key characteristic of AAPS is the rupture of the entire arterial wall,resulting in the formation of a pseudoaneurysm,with pathological features lacking the normal trilaminar arterial structure.Infectious AAPS accounts for approximately 1% of cases,with pathogens such as Staphylococcus aureus and Mycobacterium tuberculosis.Noninfectious AAPS includes immune-related cases associated with large-vessel vasculitis or Beh?et's disease,iatrogenic cases caused by endovascular or open surgical trauma,and traumatic or digestive cases resulting from external injury or enzymatic erosion,respectively.The diagnosis of AAPS primarily relies on imaging methods.Ultrasound can identify the characteristic “ying-yang sign”of blood flow,while computed tomography angiography(CTA) is the preferred modality for diagnosis and assessment of lesion extent.Magnetic resonance angiography(MRA) provides supplementary information in selected cases.The diagnosis of different types of AAPS requires careful consideration of etiology and clinical manifestations.For instance,infectious AAPS may present with sepsis,while digestive AAPS often results from gastrointestinal perforation or pancreatitis complications.Due to the high risk of rupture and mortality,timely intervention is essential for AAPS.Surgery remains the mainstay of treatment,swith options including open surgery,endovascular repair,and hybrid procedures.The management of infectious AAPS emphasizes broad-spectrum antibiotic therapy combined with debridement and vascular reconstruction,whereas non-infectious AAPS is more commonly treated with endovascular repair.Open surgery is preferred for complex lesions or cases contraindicated for endovascular treatment,while hybrid surgery combines the advantages of both open and endovascular techniques.G

关 键 词：腹主动脉假性动脉瘤 病因与分类 感染性假性腹主动脉瘤 非感染性假性腹主动脉瘤 腔内治疗 

分 类 号：R6[医药卫生—外科学]