腹主动脉瘤的外科治疗

自１９８１年至１９９４年，作者共收治包括４７例胸腹主动脉瘤在内的腹主动脉瘤患者１７８例。年龄自４岁至７９岁，平均５２．１岁。男女比例为５∶１。４例伴主动脉－上腔静脉瘘，２例腹主动脉－十二指肠瘘，１例伴由胃癌所致的幽门梗阻，６例由大动脉瘤。腹主动脉瘤采用常规手术方法。胸腹主动脉瘤用改良的ＢｅＢａｋｅｙ法、Ｃｒａｗｆｏｒｄ法或胸腹部病变分期切除法。腹主动脉瘤手术死亡率３．８％，胸腹主动脉瘤１７．４％。     

腹主动脉瘤发病机制的研究进展

随着饮食结构的改变及人口老龄化，腹主动脉瘤(abdorainal aortic aneurysm，AAA)的发病呈逐年上升趋势。对于该病的发生，近年认为是解剖、遗传、环境、生物化学等因素共同作用的结果。本就近年来AAA发病机制的研究作一综述。     

腹主动脉瘤自然病程研究

腹主动脉瘤（ＡＡＡ）在美国老年人口发病率约２％，Ｎａｓｉｍ等［１］报道近１３年腹主动脉瘤发病率逐年增加。腹主动脉瘤破裂病死率大于５０％。ＡＡＡ直径是影响破裂的重要因素，研究ＡＡＡ自然增长速度，对选择手术时机，预防破裂性手术均有意义。我们将ＡＡＡ的自然病程研究情况初步报道如下：１．材料和方法：本组５４例ＡＡＡ患者，年龄４５～８０岁，平均６７４岁；男性４８例，女性６例。瘤体直径≥４ｃｍ２１例，直径＜４ｃｍ３３例。观察期为１９８０年８月～１９９８年７月，每年对患者采用Ｂ超或ＣＴ检查，测量瘤体最大直径…     

腹主动脉瘤破裂的诊治近况

随着医学的发展,择期腹主动脉瘤的治疗已取得了令人满意的效果,但腹主动脉瘤破裂（ruptured abdominal aortic aneurysm,RAAA）的救治却仍无重大突破。近期资料表明,开腹治疗腹主动脉瘤破裂的1个月内死亡率高达34．7％～50．5％,腔内介入治疗手术死亡率也达29．9％t”。Banke等也调查发现即使在术后良好的监护治疗下,腹主动脉瘤破裂患者1个月内的死亡率也高达39％。Grant等则通过对过去13年的资料统计,表明住院腹主动脉破裂患者死亡率仍维持不变,手术死亡率达37．8％,     

腹主动脉瘤发病研究新进展

过去一直认为腹主动脉瘤 (ＡＡＡ)主要是因动脉壁粥样硬化后致动脉壁薄弱 ,薄弱处在经受动脉压力冲击后动脉壁扩张 ,最后膨胀成为腹主动脉瘤。近年来基因和生化研究等方面的进展使这一传统概念受到了强烈的冲击 ,甚至有人认为在腹主动脉瘤病人中动脉硬化为继发性或伴发的 ,这些研究表明腹主动脉瘤与基因、环境和生化因素等致主动脉组织代谢发生改变有关。一、临床发现如果说动脉壁的瘤样扩张为动脉粥样硬化所致 ,在弥漫性动脉硬化的病人中应常见周围动脉瘤和主动脉瘤共存 ,然而临床所见却非如此。另外病人因动脉粥样硬化致股浅动脉、远端动…     

胸、腹主动脉瘤三例

例 1,男 ,5 2岁。因上腹部阵发性撕裂痛 2d入院。伴恶心、呕吐。查体BP2 2 0 /12 0mmHg。胸片示左心影扩大。给予硝酸甘油静滴 1d后缓解。次日再发剧烈腹痛 ,BP 97.5 /5 2 .5mmHg ;腹膨隆 ,中腹明显压痛、反跳痛、肌紧张 ;移动性浊音 ( ) ,肠鸣音减弱。剖腹探查见腹腔积血约 2     

腹主动脉瘤动物模型研究进展

为更好地了解腹主动脉瘤 (ＡＡＡ)形成机制 ,并有利于微创腔内技术及药物治疗的研究 ,人们建立了多种实验性ＡＡＡ动物模型。一个理想的模型应该包括ＡＡＡ所有病理生理表现 :肾下腹主动脉的渐进性全层扩张与破裂、主动脉硬化、中膜基质破坏与平滑肌密度降低、中外膜炎症、蛋白溶解活性增强以及腔内血栓形成。但目前动物模型只能具备上述部分特征 ,这些模型的建立方法大致可分为三大类[1] :①遗传倾向性动物模型 ,②中外膜损伤性动物模型 ,③血流动力学诱导性动物模型。本文就此方面的研究进展作一综述。1　遗传倾向性动物模型基因敲除去除…     

Endovascular repair of abdominal aortic aneurysm: current status

INTRODUCTION: Endovascular aneurysm surgery (EVAR) was introduced a decade ago. Early results are promising, however, there remain concerns regarding the longer-term durability of this technique. Consequently, the national multi-centre EVAR trial has been commenced to define the role of endovascular surgery in the management of abdominal aortic aneurysm. DISCUSSION: Successful EVAR requires accurate pre-operative assessment of aneurysm morphology. Current stent-grafts allow 60% of all infra-renal AAA to be treated. Reduced physiological stress and low peri-operative morbidity and mortality rates have been demonstrated with this technique when compared to open repair. Endoleak is an Achilles heel of EVAR, although in itself does not accurately predict outcome. First and second generation devices are estimated to have a 1% per year risk of rupture. CONCLUSIONS: Increased understanding of the issues surrounding aneurysm morphology and successful stent-grafting have allowed a major reduction of early type I endoleak. Late endoleak and graft migration remain problematic. Type I and III endoleaks are risk factors for subsequent rupture although the significance of type II endoleak remains uncertain. More robust indicators of outcome success/failure are required so that follow-up may be rationalised.     

Inflammatory abdominal aortic aneurysm

The inflammatory abdominal aortic aneurysm has received little attention in the literature. To date only four reports have addressed the subject specifically. Controversy remains as to whether this is a variant of the usual atherosclerotic aneurysm or a separate entity. The operative reports of 24 patients with inflammatory abdominal aortic aneurysms are reviewed; 21 were intact and 3 ruptured. Intact aneurysms ranged in diameter from 5 to 12 cm and the ruptured ones from 5 to 10 cm. Nine patients with intact aneurysms had symptoms of abdominal or back pain. Of 13 patients who underwent excretory pyelography before operation, only 3 had evidence of obstruction. Nine patients had tube grafts placed, 10 had aortoiliac grafts and 5 aortofemoral grafts. There was one intraoperative duodenal injury and in another patient it was necessary to divide the left renal vein for proximal exposure. No attempt was made to expose the ureters at operation. All patients were discharged from hospital. The authors believe that the inflammatory aneurysm is a variant of the abdominal aortic arteriosclerotic aneurysm. Intraoperative complications can be avoided by the recognition of the pathological features.     

Congenital abdominal aortic aneurysm

The authors report the extremely rare occurrence of a congenital abdominal aortic aneurysm, 6 cm in diameter, found in a 1-month-old infant. Prenatal ultrasonography at 34 weeks' gestation had shown the aneurysm, which at that time was interpreted as a renal cyst. At operation, an 8-mm polytetrafluoroethylene tube graft was interposed between the infrarenal aorta and the bifurcation. Cardiopulmonary bypass facilitated operative management by permitting return of blood lost and by maintaining body temperature. In a review of the literature, the authors could not find any report of a neonatal aneurysm of this magnitude. Regrettably, the cause of this true aneurysm remains obscure.     

Ruptured abdominal aortic aneurysm

Between 1974 and 1984, 174 patients with ruptured abdominal aneurysms have been treated by three vascular surgeons. The 11-year period showed a dramatic increase in the number of patients presenting with ruptured aneurysms. The overall operative survival, including patients who died before a graft could be inserted, was 67 per cent with improvement from 60 per cent in the first half of the period to 69 per cent in the second. The overall survival rate for the 162 who had a completed graft was 72 per cent. Reference to data from the Lothian area surgical audit showed that there has been a transfer of responsibility from general to vascular surgeons with an increase in the proportion of patients treated by operation. Concentration of care within a single specialized unit appears to have had a favourable effect on survival.     

Ruptured abdominal aortic aneurysm after endovascular aortic aneurysm repair

In treating uncomplicated abdominal aortic aenurysm, endovascular aortic aneurysm repair (EVAR) has been employed as a good alternative to open repair with low perioperative morbidity and mortality. However, the aneurysm can enlarge or rupture even after EVAR as a result of device failure, endoleak, or graft migration. We experienced two cases of aneurismal rupture after EVAR, which were successfully treated by surgical extra-anatomic bypass.