破裂腹主动脉瘤的外科治疗体会(附20例报道)

Surgical Treatment for Ruptured Abdominal Aortic Aneurysm(Report of 20 Cases)

目的探讨破裂腹主动脉瘤的诊断和外科治疗方法。方法回顾性分析2000年1月至2010年12月期间新疆维吾尔自治区人民医院收治的20例破裂腹主动脉瘤患者的临床资料。结果男18例,女2例;年龄31～82岁,平均65.4岁。所有患者中突发性腹或腰背部疼痛20例,血压下降和(或)休克11例,发病前有明确腹主动脉瘤病史7例。所有患者均经彩超、CTA或手术探查确诊。19例患者采用传统开腹手术,1例行腔内支架人工血管置入术。20例患者中围手术期死亡4例,死亡率为20%,死亡原因为循环衰竭1例,多器官功能障碍综合征3例。存活的16例患者恢复顺利。结论手术治疗破裂腹主动脉瘤有效,早期诊断,急诊外科手术,是降低病死率的关键。

Objective To explore the diagnosis and treatment for ruptured abdominal aortic aneurysm（RAAA）.Methods The clinical data of 20 patients with RAAA from January 2000 to December 2010 were analyzed retrospectively.Results There were 18 males and 2 females.The age was 31-82 years with an average 65.4 years.All the patients were abdominal pain and（or）back pain.Eleven cases had low blood pressure or shock.Seven cases had a history of abdominal aortic aneurysm.All the cases were accurately diagnosed by CTA,Doppler ultrasonography or operation.Nineteen cases were treated by conventional operation,1 by endovascular aortic repair.Survival of 16 cases recovered smoothly.Perioperative death occurred in 4 cases,mortality rate was 20% in 20 patients with RAAA.The causes of death included circulatory failure in 1 case and multiple organ dysfunction syndrome in 3 cases.Conclusions Surgery treatment is an effective treatment for RAAA.Early diagnosis and urgent surgical repair are crucial to reduce the mortality of RAAA.