急性腹主动脉阻塞的诊断与治疗

Diagnosis and treatment of acute occlusion of abdominal aorta

目的 探讨急性腹主动脉阻塞的原因及其诊断和治疗。方法 回顾性分析 3 5例急性腹主动脉阻塞的临床资料。结果 急性主动脉栓塞 (AAE ) 17例 ,急性主动脉硬化血栓形成 (AAT ) 18例。腹主动脉均为完全阻塞 ,均累及双侧髂动脉。全组病例行急诊手术。双侧股动脉切开Fogarty管取栓18例 ,腹主动脉切开取栓 11例 ,主 -髂动脉人工血管重建 2例 ,主 -股动脉旁路 2例 ,双侧腋 -股动脉旁路 2例。手术死亡率 2 5 .7% (9/3 5 )。术后出现动脉栓塞再发 3例 ,截肢 3例 ,肾功能衰竭 3例 ,截瘫 4例 ,缺血性结肠炎 5例 ,性功能减退 1例及不完全性小肠梗阻 1例。结论 急性腹主动脉阻塞是一种具有很高死亡率的急症 ,尽早诊断并手术是抢救成功的关键。彩超是首选诊断方法。

Objective To study the etiology, diagnosis and treatment of acute occlusion of abdominal aorta(AOAA). Methods Clinical data of 35 patients with AOAA admitted to our hospital from January 1980 to August 2001 were analyzed retrospectively. Results There were 17 patients with acute aortic embolism(AAE) and 18 patients with acute aortic thrombosis(AAT) . All cases had total occlusion of abdominal aorta,and bilateral iliac arteries were involved. All the 35 cases underwent operations, including bilateral transfemoral thromboembolectomy by Fogarty balloon catheter in 18 cases, thromboembolectomy via laparotomy aortotomy in 11 cases, aortobiiliac reconstruction in 2 cases, aortobifemoral bypass in 2 ( 1 had profundaplasty) and axillobifemoral bypass in other 2 cases. Operative mortality was 25.7%(9/35). After the operations, artery embolism recurred in 3 cases; 3 patients required amputation; renal failure occurred in 3 cases and paraplegia in 4; ischemic colitis occurred in 5, impaired sexuality in 1 and incomplete intestinal obstruction in 1. Conclusions AOAA is an urgent disease with high mortality. Fast preoperative diagnosis and prompt operation are the keys to salvage the patient. Color Doppler is the first choice of diagnosis. Fogarty balloon catheter thromboembolectomy and vascular reconstruction are effective treatments for this disease.