手术治疗近肾动脉腹主动脉闭塞症

Surgicaltreatmnetofjuxta┐renalabdominalaorticocclusion:reportof27cases

为提高近肾动脉腹主动脉闭塞症的疗效，作者采用左肾静脉下控制腹主动脉，腹主动脉切开逆行血栓内膜切除、腹主动脉－双股（髂）动脉人造血管转流术，及腋动脉－双股动脉转流术。１０年来共收治了２７例，病因主要是动脉粥样硬化和大动脉炎所致的主髂动脉狭窄闭塞。诊断主要依据为双下肢缺血、双股动脉搏动缺失、腹主动脉搏动消失、性功能障碍及血管造影阳性结果。２５例作了手术治疗。治愈好转率８４％，死亡４例。作者认为：手术效果决定于合并症及远端流出道的好坏。术前合并症直接影响死亡率。

Juxta-renalabdominalaorticocclusionisarelativelyraredisease.Wehavetreated27pa-tients(25malesand2females)since1984.Operationswereperformedon25patients,ofwhom4diedand84%improved.Themainetiologywasaorto-iliacstenosisorocclusionduetoatherosclerosisandTakayasu′sarteritis.Diagnosticbasisincludedischemiaoflowerlimbs,pulselessnessofabdominalaortaandbothfemoralarteries,sexualdysfunction,andpositiveresultofangiography.Efectivecontrolofaortabelowtheleftrenalvein,aortotomyandretrogradeendarterectomywerethemainoperativeproce-dures.Axilo-bifemoralarterialbypassisrecommendedforpatientsassociatedwithmultiplediseases.Theoperativeresultisdeterminedbyassociateddiseasesandtheconditionofrun-ofvessel.Associateddiseasesdirectlyaffectthemortalityrate.