老年及老年前期患者无症状型腹主动脉瘤超声随访

腹主动脉瘤（Abdominal aorta aneurysm，AAA）是动脉粥样硬化较严重的并发症之一，破裂是AAA最严重的并发症，病死率极高。2000—01～2002—09，我们对2633例老年及老年前期人群无症状型AAA的患病情况进行了超声筛查，检出A从患者53例，其中5例已手术治疗，以后又对部分筛查患者进行了5—7年的随访，现报告如下。     

彩色多普勒超声对腹主动脉瘤诊断与分型价值的探讨

目的：探讨彩色多普勒超声在诊断腹主动脉瘤中的应用价值。方法：回顾性分析近6年来彩色多普勒超声首先检出的腹主动脉瘤21例，并与CT强化扫描检查对照。全部病例均经X线血管造影证实。结果：超声与CT对腹主动脉瘤的敏感性、特异性强，诊断结果可靠，但对夹层动脉瘤破裂口、真假腔问剥脱的内膜及假腔内血栓的显示等方面彩色多普勒超声比CT更为实时、便捷。根据腹主动脉瘤的声像图表现，我们将其分为：无回声型、混合回声型和膜状两腔回声型三类。结论：彩色多普勒超声对腹主动脉瘤的诊断与分型具有重要的临床诊断价值。     

彩色多普勒超声在腹主动脉瘤诊断中的临床应用价值

目的探讨彩色多普勒超声在腹主动脉瘤诊断中的应用价值。方法分析了在我院经腹部彩色多普勒超声检查发现的25例腹主动脉瘤患者的临床表现及影像学资料。结果 1)临床表现:25例患者中出现搏动性腹部包块18例,5例存在消化道不适症状,2例因剧烈腹部疼痛就诊;2)病理分类:本组25例腹主动脉瘤患者中真性动脉瘤12例,假性动脉瘤5例,夹层动脉瘤8例;3)彩色多普勒超声表现:在12例真性动脉瘤患者中瘤壁附有血栓5例。结论彩色多普勒超声检查可准确地诊断腹主动脉瘤,而且还被用于临床病例的动态观察,具有价格低廉、准确和重复性好等优势。     

腹主动脉瘤危险因素病例对照研究

腹主动脉瘤(abdominal aortic ancurysms；AAA)是动脉粥样硬化的严重并发症之一，有关研究表明，AAA的危险因素包括年龄、性别、相关疾病等，但国内这方面的研究较少。现将我们的研究结果报道如下。     

超声检查腹主动脉瘤18例

报道18例腹主动脉及其内脏分支动脉瘤的声像图、CT、血管造影及手术病理对照,其中包括腹主动脉瘤15例、肠系膜上动脉瘤、脾动脉瘤及脾静脉瘤各1例。作者认为超声是腹主动脉瘤有效的检查手段。     

腹主动脉瘤的CT

本阐述了腹主动脉瘤的病因、好发部位与流行病学。ＣＴ扫描技术和对腹主动脉瘤及其并发症的诊断。     

腹主动脉瘤腔内治疗的新进展

综述了腹主动脉瘤腔内治疗有关支架移植物的改进方向、手术适应证和并发症、技术要点及疗效和相关并发症的研究新进展,同时总结了近年来文献关于此方法的几个比较实验.     

巨大腹主动脉瘤一例

患者 女,59岁。因B超检查发现 上腹部包块,要求行CT检查。体检:于 中下腹触及一搏动性包块,大小约 10 cm×10 cm,质软,表面光滑。边界清, 轻压痛。心、肺(-)。实验室检查未见 异常。 CT表现:平扫约自第1腰椎下缘肾 动脉下水平至第5腰椎中分,左右髂总动 脉分叉处,一段长约12 cm的腹主动脉呈 瘤样扩张,位于腰椎右前方。病变最大 横径约11．5 cm。增强扫描示瘤内呈均匀 一致的血管样明显强化(图1),下腔静 脉、肠系膜上动脉及腹腔内脏器明显受     

腹主动脉瘤腔内隔绝术与外科开放手术的临床对比研究

目的:评价腔内隔绝术与外科开放手术治疗腹主动脉瘤的效果。方法:介入放射科67例临床确诊为腹主动脉瘤的患者作腔内隔绝术。血管外科71例腹主动脉瘤患者行外科开放手术。比较围手术期及术后中远期情况。结果:腔内组及外科组术中失血量分别为(145±70)ml及(360±164)ml,输血量分别为0ml及(506±261)ml,早期并发症率分别为11.9%及25.3%,手术时间分别为(2.5±1.2)h及(3.4±1.1)h,住院时间分别为(8±4)d及(15±5)d,术后30d死亡率分别为1.4%及8.5%,上述指标腔内组均少于外科组,生活质量和住院费用[(15.6±4.3)万元]高于外科组[(4.2±0.8)万元]。中远期疗效令人满意。结论:腹主动脉瘤腔内隔绝术具有创伤小、术后恢复快、心肺并发症少,中远期疗效较好等优点,但费用较高。     

主动脉瘤腔内修复术一期治愈Stanford A型主动脉夹层并腹主动脉瘤一例

Stanford A型主动脉夹层是一种灾难性疾病,病死率极高[1]。治疗主要以手术为主,即升主动脉或主动脉弓置换术,但手术创伤大,手术病死率达14%～21.6%[2]。自1991年     

国产弹性蛋白酶浸泡法构建兔腹主动脉瘤及其随访

目的采用国产猪胰弹性蛋白酶溶液主动脉周浸泡法构建兔腹主动脉瘤(AAA)模型,并随访其长期稳定性。方法 24只新西兰兔随机分成两组,实验组(n=12)用10μL浓度为10 U/μL国产猪胰弹性蛋白酶溶液浸润主动脉近分叉处血管段30 min,对照组用10μL 0.9%氯化钠溶液浸润30 min。术前和术后5、15、40、100、150 d分别经耳缘静脉造影测量主动脉内径。术后5、15、150 d造影后每组分别处死4只兔作苏木精-伊红(HE)、弹力纤维EVG染色和免疫组化染色。结果实验组术后5 d均形成AAA,主动脉直径100 d内基本稳定,150 d时明显缩小;组织学上术后5 d血管壁严重破坏、结构紊乱,可见红细胞渗出和炎性细胞浸润,弹力纤维和平滑肌细胞明显减少甚至消失,15 d时血管结构规整,可见部分残留弹力纤维,未见炎性细胞,150 d时管腔变窄,内膜过度增生,可见大量平滑肌细胞增生和紊乱的新生弹力纤维。对照组均未见AAA形成,病理学无明显变化。结论国产猪胰弹性蛋白酶溶液浸泡法可诱导兔AAA形成,操作简单、安全、有效。该模型有自愈倾向,但100 d内基本稳定,有助于AAA机制研究。     

Notes on the application of the Matsui-Kitamura stent-graft for endovascular repair of abdominal aortic aneurysm

Abdominal aortic and left common iliac aneurysms in a 79-year-old man who had undergone Miles' operation for rectal carcinoma were treated with endovascular repair of an abdominal aortic aneurysm (EVAR), taking into consideration the age, surgical history, and wishes of the patient and his family. The Matsui-Kitamura stent-graft (MK-SG) was designed based on preoperative angiographic mapping. At EVAR, the right leg of the MK-SG was caught at the aortic bifurcation because of unexpected contraction of the MK-SG. To resolve the problem, the body of the MK-SG was dilated with a balloon, slightly lifted while being gradually shortened, and eventually successfully connected to the leg of the MK-SG. Made of nitinol mesh, the MK-SG is stable and flexible enough to make it one of the best stent-grafts for EVAR. A serious drawback, however, is the high contraction rate of the MK-SG itself. It is difficult to estimate the appropriate length of the stent-graft owing to unpredictable contraction. It is important to understand its characteristics and to carefully design and acquire sufficient skills in manipulating MK-SG.     

Exercise equilibrium radionuclide angiography predicts long-term cardiac prognosis in patients with abdominal aortic aneurysm being considered for surgery

BACKGROUND: Patients with an abdominal aortic aneurysm (AAA) have a high prevalence of coronary disease and are at risk for cardiac events. This may offset the prognostic benefit of surgical repair. We investigated whether preoperative exercise equilibrium radionuclide angiography (ERNA) could be used to identify patients at high risk for cardiac events after successful AAA repair. METHODS: Between 1990 and 1995, 173 patients with an AAA were referred for supine bicycle exercise ERNA preoperatively. Follow-up information was obtained from a questionnaire sent to each patient's family physician. Cardiac events were defined as cardiac death or nonfatal myocardial infarction. RESULTS: A total of 139 patients were able to exercise and did not die or suffer myocardial infarction perioperatively. The median follow-up period was 3.8 years. Diabetes mellitus, an exercise ejection fraction (EF) below 0.50, and a fall in EF with exercise were univariable predictors of cardiac risk during the follow-up period (P < .05). On multivariable analysis, diabetes mellitus (risk ratio [RR], 6.9; 95% CI 1.5 to 32.0) and an EF fall (RR, 4.1; 95% CI 1.5 to 11.4) emerged as the most important predictors. CONCLUSIONS: Exercise ERNA predicts long-term cardiac events in patients being considered for elective AAA repair. Such predictive information may influence the decision to operate, for example, on small unthreatening aneurysms, or lead to invasive cardiological management to minimize risk.     

腔内治疗复杂巨大腹主动脉瘤1例

病例资料 患者男,74岁,既往高血压、冠心病、不稳定型心绞痛10余年,口服药物病情控制良好.5年前在当地医院发现腹部搏动性包块,超声确诊为腹主动脉瘤,大小约12 cm×8.8 cm,当时无特殊不适,未进一步治疗.2014年6月患者因“左腰背部疼痛,呈酸胀感,站立活动时明显,伴有腹胀、深呼吸受限、纳差等症状”来我院就诊,收治入院并完善相关检查.CTA示:肾动脉开口以下巨大腹主动脉瘤并附壁血栓形成,大小约16.6 cm×13.2 cm,较前增大,瘤颈角约70°;双侧髂总动脉受累并扩张;双侧髂内动脉狭窄并附壁血栓形成;左侧髂外动脉严重迂曲、折叠;主动脉全程、双侧髂内外动脉管壁粥样硬化.     

MSCT在腹主动脉瘤临床诊疗中的价值

目的：评估 MSCT在腹主动脉瘤(AAA)诊断和预后评价的价值。方法前瞻性收集本院经 MSCT 检查的26例疑似AAA患者,分析 MSCT检查的准确性和特点。结果26例患者经 MSCT诊断为 AAA,其中17例真性 AAA,9例假性 AAA。真性AAA的MSCT显示腹主动脉呈梭形扩张并向左前方膨出,瘤破裂患者残余瘤腔周围可见血栓和瘤壁钙化;假性AAA的MSCT显示腹主动脉旁偏心的膨大肿块,肿块可在血管钙化边界之外。手术诊断结果为25例 AAA,MSCT 与手术病理结果的符合率为96.1%(25/26);本组患者均出现动脉壁钙化的现象,其中17例伴有附壁血栓。结论 MSCT是一种安全、有效和无创性的诊断技术,对于AAA的早期发现,病情判断和指导治疗有较高的临床应用价值。     

多层螺旋CT血管成像在腹主动脉瘤中的诊断应用

目的探讨多层螺旋CT血管成像在腹主动脉瘤（AAA）中的诊断价值。方法30例临床疑诊AAA患者均经16层螺旋CT血管成像（MSCTA）。采用最大密度投影（M1P）、多平面重组（MPR）、容积再现（VR）技术对传送至AW4.1工作站的原始数据进行重建,获得二维或三维的立体图像。结果30例疑诊AAA患者中有7例真性腹主动脉瘤,15例假性动脉瘤,8例主动脉夹层。MPR能准确显示瘤体位置、形态、范围及附壁血栓。MIP能较好地显示瘤壁及附壁血栓内的钙化。VR技术能立体精确显示腹主动脉、瘤体及周围组织结构的空间关系。结论多层螺旋CT血管成像是一种无创、快速的检查方法,为临床诊断、治疗腹主动脉瘤提供重要信息。     

Comparison of intravenous digital subtraction angiography to conventional aortography in patients with abdominal aortic aneurysm

Evaluation of intravenous digital subtraction angiography (IV DSA) in patients with abdominal aortic aneurysm was performed by obtaining catheter aortograms immediately before DSA studies in ten patients. Diagnostic images were obtained in nine of ten digital subtraction examinations. Although repeat injections were necessary in six DSA and three conventional aortography cases for adequate imaging of both cephalad and caudal extension of the aneurysm, average contrast dose was 53 cc (62 cc in standard catheter studies). Renal artery stenosis was diagnosed by DSA in two of three vessels, multiple renal arteries were demonstrated by both modalities in two cases. Digital subtraction and conventional aortographic findings were proved at surgery. Intravenous DSA was shown to be useful in the preoperative evaluation of patients with abdominal aortic aneurysm. This work was supported in part by U.S. Public Health Service Grant No. HL07334.     

Renewed endovascular repair for recurrent acute abdominal aortic aneurysm

The aim of the study was to describe the successful endovascular management of a patient who was admitted urgently with a second episode of acute abdominal aortic aneurysm (AAA) 30 months after emergency endovascular abdominal aortic aneurysm repair (eEVAR) for a ruptured AAA. The patient, an 84 year-old male physician, presented with severe acute abdominal and back pain. Contrast-enhanced computer tomography scanning showed type III endoleak owing to complete disconnection of both graft limbs and the prosthetic main body. Treatment consisted of acute stent-grafting with two bridging stent-grafts to seal the endoleak and reline the graft. The patient is alive and well 6 months postoperatively. This case indicates the need for follow-up after eEVAR, but also that complications can be managed endovascularly.     

局部麻醉穿刺下完全无对比剂腔内修复腹主动脉瘤1例

目的 探讨对比剂过敏高危腹主动脉瘤患者接受局部麻醉穿刺下完全无对比剂主动脉腔内修复术(EVAR)的可行性.方法 对1例对比剂过敏腹主动脉瘤患者,在不使用对比剂、局部麻醉穿刺条件下实施EVAR术.结果 手术获成功.术后MRI随访结果显示,患者腹主动脉瘤完全隔绝,无内漏,覆膜支架内血流通畅,双侧肾动脉显影良好.结论 局部麻醉穿刺下完全无对比剂EVAR术治疗对比剂过敏伴全身麻醉禁忌高危腹主动脉瘤患者安全有效,但严格掌握适应证、术前充分评估是手术成功的关键.