原发性主动脉消化道瘘九例临床分析

Primary aortoenteric fistula:a report of 9 cases

目的 提高主动脉消化道瘘的诊治水平。 方法 对９ 例主动脉消化道瘘病例进行回顾性临床分析，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％ （９／１２ ４３１） ，占同期胸腹主动脉瘤的３－４％ （９／２６２） 。９ 例中男５例，女４ 例，平均年龄５６－８ 岁。均有预兆性出血特征，腹部搏动性包块和休克，６ 例出现腹痛，所有特殊检查均未能诊断主动脉消化道瘘。术中或尸解诊断主动脉十二指肠瘘４ 例，主动脉空肠瘘３ 例，主动脉横结肠瘘１ 例，主动脉食管瘘１ 例。９ 例中有５ 例行急诊手术，共有７ 例死亡，２ 例存活。３ 例行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 临床对具有出血、腹痛、腹部搏动性包块三联征，影像学检查发现患有胸腹主动脉瘤者，应高度怀疑主动脉消化道瘘可能。

Objective To improve the diagnosis and treatment for primary aortoenteric fistula. Method Retrospective analysis was made on 9 cases with primary aortoenteric fistula,and literature reviewed on its epidemic and clinical features. Results The prevalence of primary aortoenteric fistula was 0 072% out of GI bleeding patients admitted into our hospital from 1963 to 1977 and 3 4% of patients suffering from abdominal aortic aneurysm.Among them 5 were male, and 4 were female with a mean age of 56 8. All presented herald bleeding, abdominal mass and shock,6 of them had abdominal pain. Preoperative examinations were all failed to establish correct diagnosis of aortoenteric fistula.Final diagnosis was all established by laparotomy or autopsy,i.e, aortoduodenal fistula in 4 cases, aortojejunal fistula in 3 cases, aortocolonal fistula in 1 case and aortoesophageal fistula in 1 case. Seven died of the bleeding, 5 cases underwent emergent operation. Replacement of the aortic aneurysm with primary bowel repair was performed on 3 cases, 2 cases undergoing in situ graft aortic reconstruction and survived.Conclusions In patients with a history of abdominal aneurysm presenting a trial of “herald” bleeding,abdominal mass and pain,the diagnosis of primary artoenteric fistula should seriously considered.Prompt aggressive surgical intervention is mandatory for survival.