腹主动脉瘤的治疗方法与远期效果评价——腹主动脉瘤的治疗方法和中远期效果评价

随着人口老龄化，以及高血压、动脉硬化等高危因素的增加，腹主动脉瘤（abdominal aortic aneurysm．AAA）的发病率也随之增高。最新数据表明美国每年约有30，000人死于AAA破裂，一旦破裂死亡率高达90％，因此早期诊断，积极治疗，防止破裂意义重大。AAA治疗方法主要包括开放手术和腔内修复术（endovascular aortic repair，EVAR）。[第一段]     

腹主动脉瘤的治疗方法和疗效的评价

腹主动脉瘤(abdominal aortic aneurysm,AAA)是最常见的动脉瘤,是血管外科治疗的主要疾病之一。AAA破裂的总体死亡率高达80%~90%,而且AAA绝大多数与动脉硬化有关。随着社会老龄化,以及检测手段的不断提高,AAA发病率呈上升的趋势,其治疗也越来越得到重视。AAA由于有较高的破裂倾     

腹主动脉瘤的治疗方法与远期效果评价

随着饮食结构的改变及人口老龄化的加剧,以动脉硬化为主要病因的腹主动脉瘤(abdominal aor-tic anearysm,AAA)的发病率逐年上升,其最大威胁是瘤体突然破裂,出血性休克、死亡。著名科学家爱因斯坦、李四光以及著名女排运动员海曼均死于AAA破裂。近十年来尽管AAA的诊断和治疗取得     

主动脉EVAR治疗腹主动脉瘤的临床效果分析

目的:探讨采用主动脉腔内修复术(EVAR)治疗腹主动脉瘤的临床效果。方法:对2014年3月—2016年9月手术治疗的97例肾下型腹主动脉瘤患者的治疗情况进行回顾性分析。根据手术方式分为主动脉腔内修复术治疗43例(EVAR组)和传统开腹手术54例(开腹组),对比两组患者的围手术期指标及治疗效果。结果:术后24 h观察,两组患者97例均手术成功,术中无患者死亡。开腹组实施单纯人工腹主动脉瘤血管移植(I型)18例,采取腹主-双髂动脉移植(IIa和IIb型)30例,腹主-双髂股动脉移植6例(IIc型);EVAR组中I型患者选择直管型支架置入11例,IIa和IIb型15例选择主-髂单臂型支架置入,IIa、IIb及IIc型17例选择分支型支架置入。与开腹组比较,EVAR组的手术时间、术中出血量、术中输血量、ICU停留时间、术后下床活动时间、禁食时间、住院时间均明显缩短或减少(P0.05)。两组间并发症发生率差异无统计学意义(9.30%vs.11.11%,χ~2=0.085,P=0.771)。结论:主动脉EVAR治疗腹主动脉瘤较开腹手术的主要优势是手术创伤小、恢复快的优点,同时手术效果可靠。     

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％。     

腹主动脉瘤破裂的诊断和治疗

我科自1991年1月至1995年12月间共收治有症状的肾下型腹主动脉瘤16例,包括濒临破裂8例,破裂8例,全部手术或彩色超声多普勒确诊。前者全部治愈,后者手术6例仅3例成功。对濒临破裂患者及早手术是防止破裂,降低腹主动脉瘤死亡率的关键,对于直径小于5cm的腹主动脉瘤应行B超或彩色超声多普勒定期检查,了解增长速度。本文对腹主动脉瘤破裂的有关问题予以讨论,对已破裂的腹主动脉瘤,手术治疗是唯一的生存希望。     

有关腹主动脉瘤治疗中的若干问题

有关腹主动脉瘤治疗中的若干问题陈福真腹主动脉瘤（ＡＡＡ）并非真正的肿瘤，乃是腹主动脉的明显局限性扩张性疾病，在西方其发病率高达４％［１，２］，在我国腹主动脉瘤的发病率远低于西方国家，但有逐年增多趋势，本文就有关问题结合自己的临床经验谈点看法。一、有关...     

25例腹主动脉瘤的外科治疗

为了提高腹主动脉瘤外科手术的成功率及减少术后并发症的发生率，总结报道了２５例腹主动脉瘤的治疗经验。所有病人术前ＤＳＡ、ＭＲＩ等检查明确诊断，根据瘤体的情况行瘤体切除、人工血管或同种异体血管移植手术。结果本组病人手术死亡率１６％，无一例出现因腹主动脉阻断而发生主要脏器缺血性损伤的并发症。作者认为，腹主动脉瘤均应尽早行外科手术治疗。已破裂者或即将破裂的腹主动脉瘤是急诊手术的指征。     

肾动脉平面下腹主动脉瘤的外科治疗

目的：探讨肾动脉平面下腹主动脉瘤的外科治疗经验。方法：传统开放手术治疗27例中择期手术19例,动脉瘤破裂行急症手术8例;腔内手术治疗4例。结果：围手术期并发心力衰竭3例,呼吸衰竭8例,急性心肌梗死1例,急性肾功能衰竭4例,术后严重出血1例,死亡5例,余均治愈。结论：外科手术是治疗肾动脉平面下腹主动脉瘤的有效手段,而腔内治疗以其安全、微创、对人体内环境干扰小等优点将成为未来发展的趋势。     

Endovascular Treatment of Symptomatic and Ruptured Abdominal Aortic Aneurysms

Aim: To report our early experience with endovascular treatment of symptomatic and ruptured abdominal aortic aneurysms (AAA) using the Talent bifurcated stent graft.

Patients-methods: From August 2003 to May 2007 nine patients with symptomatic AAA (sAAA) (two after previous endovascular repair and endoleak), and eleven patients with ruptured AAA (rAAA) (one with ruptured iliac aneurysm and one with spontaneous aortic rupture) were treated endovascularly. Seven bifurcated stent grafts, (six Talent), and two iliac extensions were implanted into the patients with sAAA, and nine bifurcated stent grafts (eight Talent) and two aorto-uniliacs were implanted into the patients with rAAA.

Results: The deployment of the endovascular device in the intended location was successful in all patients. There was no conversion to open surgery. One patient with sAAA died after stroke and sepsis resulting in 11.1% 30-day mortality in this group. One required re-intervention for a type I endoleak before his discharge. Eight patients were discharged and during a follow-up period of 4–42 months (median 18 months) they have remained well. Two patients with rAAA died in the 30-day postoperative period. Thirty-day mortality was 18.1%. An unintended occlusion of one renal artery was performed. There were 9 survivors. During a follow-up period of 17–45 months (median 26 months) one more died of myocardial infarction.

Conclusion: Initial experience with endovascular treatment of patients with symptomatic or ruptured AAA, using the Talent bifurcated stent graft is promising. Bifurcated endografts can be implanted into patients with rAAA. A larger number of patients and longer follow-up is necessary to arrive at more reliable conclusions.