近肾动脉腹主动脉下段闭塞症的手术方法探讨

目的探讨近肾动脉腹主动脉下段闭塞症（juxtarenal aortic occlusion）的手术治疗方法。方法总结自1995年以来作者收治的27例腹主动脉末端闭塞症的临床治疗，术中暂时阻断肾上主动脉（平均7min），纵行切开主动脉，迅速清理近肾主动脉病灶，缝合上段纵行切口后改为肾动脉下主动脉阻断，完成人工血管主-股动脉转流手术。结果术后22例触及股动脉和胭动脉搏动，术后7d患肢缺血症状均得以改善。手术后3月复查，患肢缺血症状消失，25例阳痿现象得到改善，彩色超声显示血管吻合口及人工血管内均未见血栓。25例获得1年以上的随访，吻合口通畅率为100％；18例获得5年以上随访，吻合口通畅率为94．4％。结论将肾上主动脉暂时阻断后纵行切开主动脉，迅速去除病灶，主动脉缝合成型，然后在肾下主动脉阻断后完成主-股动脉转流是治疗腹主动脉末端闭塞性疾病较好的手术方案。

Surgical Treatment of Juxtarenal Aortic Occlusion

Objective To investigate the surgical treatment of juxtarenal aortic occlusion. Methods 27 cases of juxtarenal aortic occlusion treated since 1995 were retrospectively reviewed. After suprarenal aorta transitorily occluded, juxtarenal lesion was removed rapidly via a longitude incision, and then the incision was sutured closely, recanalization of the aorta-femoral shunt was completed with infrarenal aorta occluded. Results Palpable distal pulses were restored in 22 cases, limb ischemia was significantly relieved in 7 days postoperatively. According to 3 months follow-up, ischemia symptoms were completely gone and impotence got improved in 25 patients. No thrombosis was screened in vascular anastomosis and vascular graft by color ultrasound. With 1 year follow-up in 25 cases, potency rate of anastomosis was 100% ; with 5 years follow-up in 18 cases, patency rate of anastomosis was 94.4%. Conclusion The procedure is well indicated for juxtarenal aortic occlusion.