腹主动脉瘤腔内隔绝术后臀部和结肠直肠缺血防治经验

目的：总结肾下型腹主动脉瘤（IAAA）行腔内隔绝术后，盆腔直肠缺血的防治经验。方法：1997年3月至2006年7月共对72例瘤体延及单侧及双侧髂动脉分叉的IAAA实施了腔内隔绝术，其中包括单侧髂动脉分叉受累者32例，双侧髂动脉分叉受累者40例。针对髂总动脉不同的病变情况，采取保留健侧髂内动脉、一侧髂内动脉重建、髂总动脉外绑扎等不同的处理方法。结果：即时操作成功71例（98．6％），手术结束时无Ⅰ型内漏存在。术后出现臀、股部疼痛5例（6．9％），便血3例（4．2％），未发生臀、股部和结、直肠坏死。结论：术中应尽可能保留一侧髂内动脉，避免同时封闭双侧髂内动脉，是避免臀部、直肠缺血坏死的关键。

Prevention and treatment of buttock and colorectal ischemia after endovascular exclusion for the treatment of infrarenal abdominal aortic aneurysm

Objective To summarize our experience of prevention and treatment of buttock and colorectal ischemia after endovascular exclusion(EVE) for infrarenal abdominal aortic aneurysm (IAAA).Methods From March 1997 to July 2002,EVE were performed in 72 patients with IAAAs,including 37 cases involving unilateral and 35 cases of bilateral iliac bifurcations.Various techniques,including the preservation of contralateral internal iliac artery,reconstruction of uni- lateral internal iliac artery and ligation of common iliac artery,were applied according to various lesions involving the common iliac artery.Results The procedures were technically successful in 71 patients (98.6%) without the occurence of type I endo-leakage.Post-operative buttock pain occurred in 5 cases(6.9%),and bloody stool in 3 cases (4.2%),but no pa- tient developed buttock and colorectal necrosis.Conclusions It is important to preserve the internal iliac artery of one side and try to avoid occluding intemal iliac arteries bilaterally during EVE,so as to prevent the development of pelvic and colorectal ischemia and necrosis.