外科治疗腹主动脉瘤482例

Surgical treatment of abdominal aortic aneurysms:report of 482 cases

目的 探讨提高腹主动脉瘤手术安全性的方法。 方法 总结了自 196 0年 1月～ 2 0 0 1年 3月 482例腹主动脉瘤切除人工血管移植以及腹主脉瘤腔内隔绝术的经验。本组 46 1例肾动脉水平以下腹主动脉瘤 ,采用动脉瘤切除人工血管移植 430例 ,31例采用腹主动脉瘤腔内隔绝术 ,2 1例胸、腹主动脉瘤采用Crawford方法切除。采用腹膜外途径 2 1例 ,小切口 15例 ,脐下弧形切口 11例。结果 随着腹膜后途径及脐下弧形切口和小切口等应用 ,动脉瘤近端血流控制 ,动脉瘤切除以及缝合修补和腔内隔绝术等方法的更新 ,使手术的危险性明显降低 ,总手术病死率 5 .2 % ,5年存活率达 74.4%。 结论 手术技术和麻醉监护的进步 ,使腹主动脉瘤的外科治疗变得更安全。

Objective To improve the safety of abdominal aortic aneurysm (AAA) repair. Method The experience of 482 cases of AAA in surgical treatment and endovascular graft exclusion were reviewed from January 1960 to March 2001. Results Retroperitoneal approach and minimal incision was used for AAA operation. New methods for control of the 'neck' of aneurysm, aneurysmectomy and endovascular graft exclusion were applied. The danger of AAA repair obviously decreased. The operative mortality was 5 2% and the five year survival rate was 74 4%. Conclusion The improvement of surgical and anesthetic techniques made AAA resection rapid and safe.