腹膜后解剖外旁路术治疗感染性腹主动脉瘤

Treatment of infected abdominal aortic aneurysm with extra-anatomic bypass in retroperitoneum

目的探讨腹膜后解剖外旁路术治疗感染性腹主动脉瘤（IAAA）的临床效果。方法回顾分析2009年10月至2014年3月期间我院采用腹膜后旁路术治疗4例IAAA患者的临床资料。手术方式：将分叉型人工血管通过动脉瘤旁的后腹膜隧道引向腹主动脉及两侧髂外动脉,并做人工血管-肾下腹主动脉端端吻合及髂外动脉端侧吻合,关闭后腹膜;切开动脉瘤清理瘤腔,缝扎腰动脉及髂总动脉远段（根据水肿情况尽量保留髂外逆流血入髂内通路）,双氧水及稀释碘液处理瘤腔,瘤腔置引流管并填塞缝固大网膜。除1例患者于入院当天行急诊手术外,余3例术前给予抗生素4周,患者术后均给予抗生素治疗4~6周。结果本组围术期无死亡,术后3~5周出院;随访6个月至5年,所有病例无发热、腹痛,情况良好。结论腹膜后解剖外旁路术是治疗IAAA的有效手段。

Objective To study the clinical effect of retroperitoneal extra-anatomical bypass for the treatment of infectious abdominal aortic aneurysm. Methods The data of 4 cases of infectious abdominal aortic aneurysm treated by retroperitoneal bypass operation were analyzed retrospectively. Surgical procedures were performed as follows： A retroperitoneal tunnel was made to place the bifurcate vasculargraft, and three ends of the graft were separately led to abdominal aorta and to each external iliac arteries. The graft was anastomosed to abdominal aorta in end to end way,and to each external iliac arteries in end to side way. After closure of the posterior peritoneum, the aneurysm was excised and its inside was cleaned up, and the lumbar arteries and distal common iliac artery were sewed up（the reverse the blood flows from external to internal iliac arteries should be reserved as much as possible）. The inside of the aneurysm was treated with hydrogen peroxide and dilute iodine, then drain tube was placed, omentum majus was rammedand stitched up. Except for1 case of emergency, antibiotics were used for about 4~6 weeks before and after the operation. Results There was no death case during the perioperative period. All patients discharged 3~5 weeks after operation. During a follow up of 0.5~5 years,no patient suffered from fever or abdominal pain. Conclusion Retroperitoneal extraanatomical bypass is an effective way to treat abdominal aortic aneurysm.