腹主动脉肠瘘六例的诊治体会

The diagnosis and treatment of aortoenteric fistula

目的探讨腹主动脉肠瘘的临床表现特征和治疗经验。方法对我院６例腹主动脉肠瘘进行回顾性分析。结果６例病人，男女各３例，年龄２５～７０岁；４例病理检查为动脉粥样硬化性腹主动脉瘤，年龄均６０岁以上，２例动脉中层发育不良，年龄为２５岁和３２岁；４例术前有小量多次上消化道“信号性出血”，２例突发大出血，术前诉腰部背部疼痛４例；５例为肾下型腹主动脉瘤，１例为胸腹主动脉瘤；瘘口部位３例在十二指肠第三段，２例空肠上段，１例横结肠；４例手术，２例行人造血管移植，均生存至今，１例双侧腋股动脉旁路，１例术中未找到出血部位，后２例术后死亡；另２例未来得及手术死亡。结论术前确诊腹主动脉肠瘘不容易，凡患者腹部有搏动性动脉瘤，腹部或背部剧烈疼痛，上消化道少量多次出血，应积极手术治疗。

Objective To investigate the clinical features and summarize treatment experience for patients with aortoenteric fistula (AEF).KG2 Methods Clinical data of 6 patients with AEF in our hospital were analyzed retrospectively. Results In this group there were three male and three female patients ageing 25 to 70.Four were of atherosclerotic abdominal aortic aneurysms,with the age all above 60.Two were suffering from dysplasia of the arterial media,with the age of 25 and 32.Repeated upper gastrointestinal haemorrhage of small amounts (herald hemorrhage) occured before laparotomy in 4 cases,sudden unprecedented massive bleeding in 2 cases.Four complained pain on the lumbus and the back.5 suffered from infrarenal AAA, 1 from thoracicoabdominal aortic aneurysm.The fistula was located at the third portion of duodenum in 3 cases,at the upper section of jejunum in 2 cases,and at the transverse colon in one.Two underwent replacement of the aorta with prosthetic graft material,who survived the surgery,bilateral axillaryfemoral bypass was performed in one,and in another case the bleeding site was not detected.Those 2 patients died postoperatively.The remaining two patients died of massive bleeding without exploration. HZConclusions It is not easy to make a definite diagnosis of AEF.So all the patients who have pulsatile aneurysms in the abdomen,acute pain on the lumba or the back and repeated small amounts of upper gastrointestinal haemorrhage,should undergo laparotomy without delay.