破裂腹主动脉瘤的治疗体会

TREATMENT OF RUPTURED ABDOMINAL AORTIC ANEURYSM

目的探讨破裂腹主动脉瘤(ruptured abdominal aortic aneurysm,RAAA)的诊断和治疗方法。方法 1996年1月-2009年12月,收治14例RAAA患者。男13例,女1例;年龄50～82岁,平均65岁。患者均有腹痛及腰背痛,伴低血压或休克10例。出现症状至就诊时间均>24h,其中3例>3d。患者均经彩色超声多普勒血流探测仪、CT或手术探查明确诊断。瘤体直径4.5～8.0cm。肾动脉下型12例,其中1例为原发性腹主动脉十二指肠瘘;肾动脉上型2例。11例采用传统开腹手术,1例行腔内支架人工血管移植术,1例保守治疗,1例入院后抢救无效死亡。结果手术治疗12例中死亡6例,死亡率50%;保守治疗1例死亡;总死亡率57.14%(8/14)。手术治疗患者死亡原因:循环衰竭2例,多器官功能障碍4例。其余6例手术治疗患者切口均Ⅰ期愈合;除1例术后出现不完全性肠梗阻,经保守治疗好转外,其余患者均恢复顺利。术后住院时间12～34d,平均14d。术后4例获随访,随访时间11～40个月。无相关并发症发生。结论手术仍是治疗RAAA的主要方法。早期诊断,适时复苏,急诊外科手术,是降低病死率的关键。

Objective To explore the diagnosis and treatment of ruptured abdominal aortic aneurysm （RAAA）. Methods Between January 1996 and December 2009, 14 patients with RAAA were treated. There were 13 males and 1 female with an average age of 65 years （range, 50-82 years）. The main clinical manifestations were abdominal pain and/or back pain. Ten cases had low blood pressure or shock. All cases were accurately diagnosed with CT, Doppler ultrasonography, or operation. The aneurysm diameter was from 4.5 cm to 8.0 cm. Eleven cases were treated by conventional operation, 1 by endovascular aortic repair, 1 by conservative treatment, and 1 case died after admission treatment. Results Perioperative death occurred in 6 cases （mortality rate was 50%） in 12 surgical patients. One case died after conservative treatment. The overall mortality rate was 57.14% （8/14）. The causes of death included circulatory failure in 2 cases and multiple organ failure in 4 cases. The other 6 cases were cured. The postoperative hospitalization days were 12 to 34 days （14 days on average）. A total of 4 cases were followed up 11 to 40 months without related complication. Conclusion Surgical treatment is still a main method to treat RAAA. Early diagnosis, appropriate resuscitation, and urgent surgical repair are crucial to reduce the mortality rate of RAAA.