主动脉夹层动脉瘤的CT诊断

目的：探讨CT扫描对主动脉夹层动脉瘤的诊断价值.方法：对15 例主动脉夹层动脉瘤的CT征象进行分析,以了解该病的特征性CT征象.结果：CT诊断的直接征象为不同密度的真、假两腔及剥离的内膜瓣、钙化内移的内膜.结论：CT扫描是诊断主动脉夹层动脉瘤首选的影像学方法,具有准确、快速、无创伤的特点,对该病的诊断及治疗具有重要意义.     

杂交技术治疗胸腹主动脉瘤和夹层

Background Hybrid procedures including debranching of visceral and renal arteries followed by endovascular exclusion of the thoracoabdominal aortic aneurysm (TAAA) have recently been proposed as a less...     

升主动脉瘤的外科治疗分析

目的总结升主动脉瘤的外科治疗经验。方法23例主动脉根部病变患者（年龄22～55岁,平均31．8岁）,其中Mafan’s综合征12例,Stanford A型主动脉夹层8例,主动脉瓣狭窄伴升主动脉扩张3例。手术类型：Bentall手术18例,Wheat手术3例,David手术1例,全弓置换加象鼻手术1例。结果全组手术死亡1例,术后随访12例平均41个月,无并发症。结论Bentall手术是治疗升主动脉瘤的主要术式,主动脉瓣叶正常,瓣膜轻度关闭不全,瓣环无明显扩张,David手术可以减少换瓣后服用抗凝药物所致的出血、血栓等并发症。     

Improved Prognosis of Thoracic Aortic Aneurysms: A Population-Based Study

Context.— Managing thoracic aortic aneurysms identified incidentally by increased use of computed tomography, echocardiography, and magnetic resonance imaging is problematic, especially in the elderly. Objective.— To ascertain whether the previously reported poor prognosis for individuals with thoracic aortic aneurysms has changed with better medical therapies and improved surgical techniques that can now be applied to aneurysm management. Design.— Population-based cohort study. Setting and Patients.— All 133 patients with the diagnosis of degenerative thoracic aortic aneurysms among Olmsted County, Minnesota, residents between 1980 and 1994 compared with a previously reported cohort of similar patients between 1951 and 1980. Main Outcome Measures.— The primary clinical end points were incidence, cumulative rupture risk, rupture risk as a function of aneurysm size, and survival. Results.— In contrast to abdominal aortic aneurysms, for which men are affected predominately, 51% of thoracic aortic aneurysms were identified in women who were considerably older at recognition than men (mean age, 75.9 vs 62.8 years, respectively; P=.01). The overall incidence rate of 10.4 per 100,000 person-years (95% confidence interval [CI], 8.6-12.2) between 1980 and 1994 was more than 3-fold higher than the rate from 1951 to 1980. The cumulative risk of rupture was 20% after 5 years. Seventy-nine percent of ruptures occurred in women (P=.01). The 5-year risk of rupture as a function of aneurysm size at recognition was 0% for aneurysms less than 4 cm in diameter, 16% (95% CI, 4%-28%) for those 4 to 5.9 cm, and 31% (95% CI, 5%-56%) for aneurysms 6 cm or more. Overall 5-year survival improved to 56% (95% CI, 48%-66%) between 1980 and 1994 compared with only 19% between 1951 and 1980 (P<.01). Conclusions.— In this population, elderly women represent an increasing portion of all patients with clinically recognized thoracic aortic aneurysms and constitute the majority of patients whose aneurysm eventually ruptures. Overall survival for thoracic aortic aneurysms has improved significantly in the past 15 years.      

塞来昔布抑制实验性大鼠腹主动脉瘤的形成

目的研究塞来昔布对实验性大鼠腹主动脉瘤形成的抑制作用。方法Wister大鼠24只,随机分为2组,实验组12只,对照组12只。实验组术后胃灌注塞来昔布,对照组胃灌注生理盐水。观察两组动脉瘤的形成率和动脉壁组织学改变,并用免疫组织化学技术和分子原位杂交技术检测基质金属蛋白酶2和9的表达。结果 灌注两周后实验组大鼠腹主动脉瘤形成率8.33％,对照组大鼠腹主动脉瘤形成率100％,两组差异有显著意义(P<0.01)实验组大鼠动脉壁组织基质金属蛋白酶2和9的表达为弱阳性或阴性,对照组动脉壁组织中两着表达明显增高。原位杂交检测结果表明两组mRNA表达强度无明显差异。结论塞来昔布能够通过抑制动脉瘤组织中基质金属蛋白酶2和9的表达来阻止动脉壁组织弹力纤维的降解,并抑制实验性大鼠腹主动脉瘤的形成。这为人类对小腹主动脉瘤的药物治疗提供了可行性的理论依据。     

主动脉动脉瘤92例尸检材料分析

本文报告92例主功脉动脉瘤的尸检材料,包括粥样硬化性动脉瘤65例、夹层性动脉瘤26例和霉菌性动脉瘤1例。年龄在37岁至96岁之间,平均年龄为71.8岁。动脉瘤合并破裂52例,占全部病例的56.5%。46例由于动脉瘤破裂所致急性出血性体克和急性心包填塞而死亡。26例(28.3%)临床表现为猝死。66例住院患者死亡前临床获诊者32例,占全部位院病例的48.5%。文中对主动脉动脉瘤的发病原因、病理特征、并发症和临床表现进行了讨论。     

Oncol2012: 破裂型腹主动脉瘤开放手术与腔内修复术中远期疗效的比较：Meta分析

Purpose: To compare and summarize published results of ruptured abdominal aortic aneurysms undergoing endovascular repair with open surgical repair. Methods: A search of publicly published literature was performed. Based on an inclusion and exclusion criteria, a systematic meta-analysis was undertaken to compare patient characteristics, complications, short term mortality and medium-long term outcomes. A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences. A quantitative method was used to analyze the differences between these two methods. Results: A search of the published literature showed that fourteen English language papers comprising totally 1,213 patients of ruptured abdominal aortic aneurysm (435 endovascular repair and 778 open surgical repair) would be suitable for use in this study. Furthermore, 13 Chinese studies are included, there are totally 267 patients of rAAA, among which there are 238 patients received operation. The endovascular method was associated with a more respiratory diseases before treatment (OR=1.81, P= .01), while there are more patients with hemodynamic instability before treatment in open surgical repair group (OR=1.53, P= .031). Mean blood transfusion was 1,328ml for endovascular repair and 2,809ml for open surgical repair (WMD-1500ml, P= .014). The endovascular method was associated with a shorter stay in intensive care (WMD-2.34days, P< .001) and a shorter total postoperative stay (WMD-6.27days, P< .001). The pooled postoperative complication rate of respiratory system and visceral ischemia was seldom occurred in EVAR group (OR=0.48, P< .001 and OR=0.28, P= .043 respectively). The pooled 30-day mortality was 25.7% for endovascular repair and 39.6% for open surgical repair, and the odds ratio was 0.53 (95 per cent CI: 0.41-0.70, P< .001). There was not, however, any significant reduction in the medium-long all-cause mortality rate (HR=1.13, P= .381) and re-intervention rate (OR= 2.19, P= .243) following endovascular repair. In EVAR group, nevertheless, incidence of type I endoleak was significantly lower than type II endoleak (OR=0.33, P= .039) at late follow-up period. Conclusion: On the basis of this systematic review ruptured abdominal aortic aneurysm endovascular repair results in less blood used for transfusion, shorter operation time, shorter intensive care unit and hospital stays and lower 30-day mortality. However, in the medium-long term, it is not associated with a reduction in all-cause mortality.     

脑动脉瘤的显微外科技术

1984年3月～1985年4月连续完成颈内动脉系脑动脉瘤显微手术9例,操作常规按照Ya sargil法,作了适当修改:共计动脉瘤12个(3例为多发性),包括1例颈内动脉分叉处巨大无颈动脉瘤的孤立加EIAB一期手术,皆取得良好效果。术后脑血管造影复查动脉瘤均已完全消失,痊愈出院。随访6～12月,皆恢复正常生活与工作,无后遗症。     

颈内动脉床突旁动脉瘤的血管内治疗

目的总结血管内栓塞治疗颈内动脉床突旁动脉瘤的经验体会。方法回顾性分析应用血管内栓塞治疗的31例床突旁动脉瘤患者(33个动脉瘤)的临床资料、栓塞过程以及结果。其中3例辅以球囊瘤颈再塑形技术,2例采用支架辅助弹簧圈进行栓塞,2例采用双微导管技术。结果栓塞术后即时造影显示26个动脉瘤100%栓塞;6个动脉瘤>95%栓塞;1个动脉瘤<95%栓塞。术中破裂1例,最后顺利致密栓塞。2例术后持续轻度头痛,1例遗留视野缺损。无死亡病例。随访2~48个月,无术后再出血病例。结论选择合适的床突旁动脉瘤病例,可以应用血管内栓塞进行相对微创且安全有效的治疗。     

主动脉夹层与主动脉瘤手术的临床麻醉分析

目的:回顾性分析总结主动脉夹层与主动脉瘤外科手术的麻醉实施方案及重要脏器的保护方法。方法:分析33例行升主动脉替换、全弓替换加支架象鼻手术患者的麻醉方法以及术中监测、循环管理、内环境调控和脑、肾、血液保护的情况。结果:本组病例中,平均体外循环时间(245±49)min,术中平均失血量(2150±820)ml,平均输库血量(1870±490)ml。2例病人术后1周内有轻微神经系统症状,2例病人合并有急性肾功能衰竭,1例心包填塞行二次开胸止血,1例术后发生急性心肌梗死,并发症发生率18.1%。本组共有3例病人在术后早期死亡,死亡率9.9%。本组病例无麻醉死亡.结论:动脉夹层与主动脉瘤手术的麻醉应着重强调麻醉诱导及维持的平稳,循环功能的稳定,脑、肾、血液保护和机体内环境的平衡。     

Beta-catenin在颅内动脉瘤中的表达

目的通过观察Beta-连环蛋白（Beta-catenin）在颅内动脉瘤中的表达,探讨颅内动脉瘤发生、发展及破裂的相关因素。方法用免疫组织化学方法检测30例脑动脉瘤标本中Beta-catenin的表达,同时将5例正常脑动脉组织作为对照。结果Beta-catenin在正常脑动脉壁表达阳性,平均分值3.0±0.0;未破裂动脉瘤中表达稍弱,平均分值2.1±0.3;破裂动脉瘤壁表达最低,平均分值1.0±0.3,组间比较,差异有统计学意义（P〈0.05）。结论Be-ta-catenin在颅内动脉瘤壁表达下降,在破裂动脉瘤壁仅有少量表达。Beta-catenin可能与颅内动脉瘤的形成和破裂密切相关。