摘要
目的为提高临床罕见的、死亡率高的主动脉消化道瘘的诊治水平和术后存活率。方法报告主动脉消化道瘘9例,作回顾性临床分析,并结合文献对该病的流行病学特征、临床诊治进行探讨。结果主动脉消化道瘘发生率占同期收治消化道出血的0.072%(9/12431),占同期胸腹主动脉瘤的3.4%(9/262)。9例均有“herald”出血特征和腹部搏动性包块,6例出现腹痛,所有特殊检查未能诊断主动脉消化道瘘。9例中7例死亡,2例存活。3例经主动脉瘤及肠瘘手术,其中原位人工血管置换术2例存活。结论临床对具有“herald”出血、腹痛、腹部搏动性包块三联征,影像学检查患有胸腹主动脉瘤者,应高度怀疑主动脉消化道瘘可能。迅速积极的手术是抢救生命唯一有效的治疗方法。主动脉瘤切除,原位人工血管置换,肠瘘封闭是可取的手术方式。
objective To improve the level of the diagnoses and treatment for rare primary aortoenteric fistula and postoperative survival rate.Method Case report and the retrospective analysis were made on 9 cases with primary aortoenteric fistula.Results Occurrence rate of primary aortoenteric fistula was 0.072% of gastrointestinal bleeding at the same period and 3.4% of abdominal aortic aneurysm.All cases had“her- ald”bleeding,abdominal mass.and 6 had abdominal pain.All special exams failed to diagnosis of aortoen- teric fistula.Replacement of the aortic aneurysm with primary bowel repair was performed on 3 cases,in whom,2 cases underwent in situ graft aortic reconstruction and survived.Conclusion A high index of sus- picion as aortoenteric fistula should be based on a history of“herald”bleeding,abdominal mass and pain with radiologic examinations of an abdominal aneurysm.Prompt aggressive surgical intervention is mandatory for survival and a successful outcome.In situ prosthetic replacement of the aortic aneurysm with bowel repair is available.
