摘要
流行病学研究显示,在过去的30年中,腹主动脉瘤(AAA)的发病率上升了7倍。与AAA有关的主要危险因素包括男性、吸烟、年龄65岁以上、伴冠状动脉疾病,高血压、有心肌梗死、外周动脉疾病病史和有AAA家族史。对伴有危险因素的人群进行影像学筛查可降低AAA相关的病死率。对于动脉瘤直径<5 cm的无症状AAA病人,应定期监测,根据动脉瘤大小、增长速率和临床症状来决定手术时机。开放手术或主动脉腔内修复(EVAR)治疗AAA是最主要的治疗手段,两者手术死亡率和存活率差异无统计学意义,但EVAR因微创、恢复快,已成为首选疗法。临床研究已经证明,药物治疗对于AAA作用有限。AAA破裂病情危急,围住院期病死率很高,治疗具有挑战性。提高AAA破裂病人存活率的关键因素是尽量减少发病到手术干预的时间,以及具有一支既有开放手术又有EVAR治疗AAA丰富经验的手术团队。
The epidemiology research in the past 30 years has shown that the prevalence of abdominal aortic aneurysm(AAA) has increased 7 times. The main risk factors for AAA are male sex,smoking history,age over 65,coronary artery disease, hypertension, previous myocardial infarction,peripheral artery disease and a family history of AAA. Imaging screening tests offered to susceptible people can help to decrease mortality from AAA. For asymptomatic patients of AAA with a diameter of less than 5 cm,regular follow-up should be taken to determine the timing of the operation according to the size,growth rate and clinical symptoms of aneurysms. The two main treatments for AAA are open and endovascular repair,with no significant mortality difference between the two. However,EVAR has been preferred for minimally invasion and faster recovery. The clinical studies have shown that medical therapy had limited effect. The treatment of ruptured AAA is challenging due to its emergency and high perioperative mortality. The key factors for the survival of patients with ruptured AAA are to decrease the time from onset to operation,and to have a team with rich experience in both open surgical and endovascular practice.
出处
《中国实用外科杂志》
CSCD
北大核心
2017年第12期1345-1349,共5页
Chinese Journal of Practical Surgery
关键词
腹主动脉瘤
筛查
开放手术
主动脉腔内修复
abdominal aortic aneurysm
screening
open operation
endovascular aortic repair
