肾动脉平面以上主动脉瘤的治疗

目的　探讨肾动脉平面以上主动脉瘤 (AAARA)的治疗经验。方法　回顾性分析12 0例AAARA的临床资料。结果　夹层动脉瘤 84例 ,真性动脉瘤 2 7例 ,假性动脉瘤 9例。病变累及全程主动脉者 12例 ,主动脉弓 9例 ,胸降主动脉 2 0例 ,降胸至腹主动脉分叉部或以下 43例 ,胸腹主动脉 2 5例 ,涉及内脏动脉 11例。施行手术或支架型人工血管微创治疗74例。术中至术后 30d内死亡 11例 (14 9% )。术后并发症 9例 ,无截瘫、偏瘫或卒中发生。 16例腔内治疗病人中无严重并发症或死亡者。随访 48例 ,随访时间 1个月～ 15年 ,5例死亡 (10 4% )。保守治疗 46例中 ,44 1%死于瘤体破裂或其它严重并发症。结论　AAARA开胸手术仍存在着很大风险 ,而多种多样的支架型人工血管腔内置放和腔内开窗治疗有着良好前景 ,腔内血管外科技术将成为治疗AAARA的主流。

Management of aortic aneurysms above renal arteries

Objective To sum up the experience in treating 120 aortic aneurysms above the renal arteries(AAARA). Methods The clinical data of 120 patients with AAARA were reviewed, including male in 97 and female in 23. The age ranged from 18 to 83 with a mean of 46.4 years. Dissecting, true, and false aneurysms were in 84, 23 and 9 cases respectively. The lesions involved the whole aorta in 12, aortic arch in 9, descending aorta in 20, descending aorta and abdominal aorta or even below in 43, thoracoabdominal part in 25, relating visceral trunks in 11. Seventy four cases underwent surgical or endograftiing management. Results Postoperative 30 days mortality was 14.9%(11 cases). Postoperative complications occurred in 9 cases, but none occurred hemiplegic paralysis, paraplegic paralysis or apoplexy. No mortality and severe complications occurred in enodgrafting group. 48 patients had follow up for 1 month to 15 years, of them, 5 cases died(10.4%). In conservative group(40 cases), 44.1% died of aneurysm rupture or severe complications. Conclusions Surgery for AAARA is still a very risky challenge. Treating AAARA by various endografts may have a promising future.