摘要
目的:就肾下型腹主动脉瘤的治疗经验,讨论外科手术的实用性和前途。方法:回顾分析1992年1月至2004年2月择期行肾下型腹主动脉瘤切除术187例,将其结果与经腔内治疗者作比较。结果:围手术期死亡1例(0.54%),死亡原因是术后6h出现频发室性早搏、室颤,诱发大面积心肌梗死。手术时间平均为3.8h;出血量平均470ml,输血量445ml。ICU内恢复时间为12～24h。围手术期并发症包括心力衰竭17例,呼吸衰竭8例,急性心肌梗死2例,急性脑梗死1例,急性肾功能衰竭3例,无术后严重出血或失血性休克发生,也无下肢动脉栓塞发生。术后1、3、5年生存率分别为97.0%、84.6%及78.3%,随访期间病人死亡者的原因与腹主动脉瘤和手术无关。经腔内治疗手术目前仍有较高的中、远期并发症。结论:瘤体直径不能作为手术适应证的唯一指标。术前同时应确切评价全身重要脏器功能。影响腹主动脉瘤手术的危险因素主要是高龄、严重心、肺疾患及肾功能不全等。迄今,经腹手术仍是治疗腹主动脉瘤的主要方法。
Objective To summarize experience of open surgical resection in the treatment of infra-renal abdominal aortic aneurysms (AAA) and to discuss the its practicality and prospects. Methods the data of 187 cases of infra-renal AAA treated by open surgical resection between January 1992 and February 2004 were retrospectively reviewed, and compared to that of endovascular repair. Results Only one patient died 6 hours after operation due to repeated ventricular premature beats, and ventricular fibrillation that resulted in myocardial infarction. The overall mortality was 0.54 %. The duration of operative procedure varied from 3 to 6 hours (mean duration: 3.8 hours). The mean volume of blood loss was 445 ml, ranging between 200 and 1500 ml. The recovery period in the ICU varied from 12 to 24 hours. Perioperatively, 17 patients presented heart failure, 8 patients presented respiratory failure, and 2 patients had acute myocardial infarction, 1 patient developed cerebral infarction, and 3 patients developed acute renal failure; no severe bleeding, shock or arterial embolism occurred. The 1, 3 and 5-year survival rates were 97%, 84.6% and 78.3% respectively. Among the deaths that occurred during the follow-up period, no one was associated with the aneurysm and the operation. Compared to open resection, endovascular repair showed a higher incidence of medium-term and long-term complications. Conclusions The aneurysmal diameter is not the only indication for operation. Preoperative assessment of vital systemic conditions is equally important. The risk factors of open operation on AAA are old age, severe cardiac and pulmonary diseases and poor renal function. Surgical resection of AAA is a relatively safe procedure. It is still the best option in the treatment of AAA.
出处
《外科理论与实践》
2005年第1期35-37,41,共4页
Journal of Surgery Concepts & Practice
关键词
主动脉瘤
腹
血管外科手术
对比研究
Aortic aneurysm,Abdominal
Surgical procedure
Comparative study
