摘要
目的探讨急诊腹主动脉瘤切除人工血管移植术治疗破裂腹主动脉瘤的经验。方法总结1999年4月至2005年4月外科手术治疗破裂腹主动脉瘤20例,采用钳夹阻断膈下腹主动脉或Foley氏球囊管腔内阻断瘤颈上腹主动脉后行急诊腹主动脉瘤切除人工血管移植术,应用分叉型人工血管12例,直型人工血管8例。结果急诊腹主动脉瘤切除人工血管移植手术30 d围手术期死亡率40％(8例)。死亡原因包括急性肾功能衰竭4例,多器官功能衰竭2例,呼吸循环衰竭2例。存活12例,术后合并症包括急性肾功能不全、肺部感染、凝血机制障碍和腹泻等共11例,均经治疗后痊愈。随访观察6-60个月,无人工血管血栓形成和感染等并发症以及随访期死亡发生。结论破裂腹主动脉瘤外科手术治疗死亡率仍然很高,早期确定诊断,紧急外科手术治疗,术后加强围手术期管理是降低破裂腹主动脉瘤死亡率的关键。
Objective To evaluate surgical management of ruptured abdominal aortic aneurysm （RAAA）. Methods Clinical data of 20 RAAA patients undergoing emergent graft replacement from Apr 1999 to Apr 2005 were retrospectively analyzed. Surgical procedures included clamping infra-diaphragmic abdominal aorta or Foley＇ s balloon catheter to control bleeding and graft replacement. Results Perioperative death occurred in 8 cases including acute renal failure in 4 patients, multiple organ failure in 2 patients and respiratory and circulatory failure in 2 patients respectively. The perioperative 30-day mortality rate was 40%. Major postoperative complications developed in 11 out of the 12 survivors including acute renal insufficiency, pulmonary infection, coagulopathy, and diarrhea, all were cured by intensive therapy. These 12 cases were discharged and followed up for 6 to 60 months without death or major untoward events. Conclusion Emergent graft replacement in RAAA cases still carries a high mortality. Early diagnosis, urgent surgical repair and effective perioperative management are measures conducive to lowering the mortality rate of RAAA.
出处
《中华普通外科杂志》
CSCD
北大核心
2006年第7期470-472,共3页
Chinese Journal of General Surgery
关键词
动脉瘤
破裂
血管外科手术
主动脉瘤
腹
Aneurysm, ruptured
Vascular surgical procedures
Aortic aneurysm, abdominal
