腹主动脉瘤72例诊断和外科治疗分析

Diagnosis and Surgical Treatment of Abdominal Aortic Aneurysm in 72 Patients

目的 总结分析腹主动脉瘤的诊断和外科治疗经验。方法 回顾性分析自 1995年 1月至 2 0 0 4年 2月我科收治的 72例腹主动脉瘤患者的临床资料。术前根据患者症状和体征 ,分别采用彩色多普勒超声、CT、MRA和DSA检查明确诊断和拟定手术方案。其中肾动脉下型腹主动脉瘤行择期腹主动脉瘤切除、人造血管移植术 5 8例 ;肾动脉上型假性腹主动脉瘤行择期囊内修复术 1例 ;肾动脉上型腹主动脉瘤行择期腹主动脉瘤切除人造血管移植术 1例 ;腹主动脉瘤破裂行急诊腹主动脉瘤切除、人造血管移植术 12例。结果 彩色多普勒超声、CT、MRA和DSA检查均能确诊腹主动脉瘤 ;5 8例肾动脉下型腹主动脉瘤切除、人造血管移植择期手术 ,术后死于多器官功能衰竭 2例 ,死亡率为 3.4 5 % ,其余病例和 2例肾动脉上型腹主动脉瘤均获临床治愈。 12例腹主动脉瘤破裂者临床治愈 7例 ,5例术后死于多器官功能衰竭 ,死亡率为 4 1.6 7%。结论 加强腹主动脉瘤手术患者围手术期评估和管理 ,尤其是保证术中内环境稳定 ,减少术中失血 ,可使腹主动脉瘤手术更为安全。

Objective To review retrospectively our experience of the diagnosis and surgical treatment in patients with abdominal aortic aneurysm(AAA).Methods The diagnosis and surgical treatment in 72 patients 〔62 men, 10 women; mean age (67.5±9.3) years)〕 with AAA from January 1995 to February 2004 were analyzed. Fifty eight patients with infrarenal AAA and 2 patients with suprarenal AAA underwent elective graft replacement operation; 12 patients with ruptured AAA underwent urgent graft replacement operation. Results Fifty eight patients with infrarenal AAA and 2 patients with suprarenal AAA were cured and 2 patients with infrarenal AAA died of multiple organ failure after elective graft replacement operation, the 30 day mortality rate in patients with infrarenal AAA after elective operation was 3.45%. Seven patients were cured and 5 patients died of multiple organ failure after urgent graft replacement operation, the 30 day mortality rate was 41.67%. Conclusion The elective graft replacement operation in patients with AAA is a safe and effective surgical approach under the improvement of surgical technique and management of perioperative period.