主动脉病变的手术治疗与腔内血管外科治疗

目的 探讨主动脉病变的手术治疗和腔内血管外科治疗方法。方法 回顾性分析45例胸腹主动脉病变外科治疗的临床资料。结果 男37例，女8例。年龄2l～85(平均年龄64、7)岁。其中胸主动脉夹层ll例；降主动脉夹层破裂并假性动脉瘤形成伴椎骨破损2例；肾上，下型腹主动脉瘤各为3，23例；腹主动脉瘤破裂2例；腹主动脉瘤空肠瘘l例；腹主动脉外伤性破裂3例。45例患者中腔内治疗者l8例，25例行人工血管置换治疗，3例行腹主动脉修补。围手术期死亡率为6．7％(3／45)。随访36例，随访时间2个月～4年，均生存良好。结论 腔内血管外科治疗有着创伤小，术后恢复快，并发症少等优点，有条件行支架型人工血管腔内治疗的可优先考虑腔内治疗。传统手术方法在技巧等方面的改进有利于提高手术的成功率，并能为不具备腔内治疗条件的患者解除疾苦。

Surgical management of aortic diseases

Objective To explore the surgical management of aortic diseases. Methods The clinical data of 45 cases of aortic diseases were analysed retrospectively. Results There were 37 males and 8 females.The age ranged from 21 85 years with a mean age of 64.7 years, Among these cases, 11 were thoracic aortic dissection, 2 were ruptured descending aortic local dissection and formed an aneurysm;above and below the renal artery abdominal aortic aneurysms( AAAs) were 3 and 23 respectively; complicated with rupture of the AAA in 2, and with aortojejumal fistula in 1;the other 3 cases were traumatic aortal rupture. Among the 45 cases, 18 underwent endoluminal treatment, 25 underwent AAA resection and artificial vessel implantment, and 3 underwent repair of the ruptured aorta. The operative mortality was 6.67% ( 3/45 ). 36 patients were followed up for 2 months to 4 years, all the 36 patients still alive well. Conclusions In the management of appropriate aortic diseases, endoluminal technique is much simple,safe, less trauma, and less complications, it can also short the hospital stay of the patient . However, with improvement of the surgical skills,the surgical operation is still very important and effective, especially for the cases who can not be treated via endovascular technique.