近肾动脉腹主动脉闭塞诊治分析

目的探讨采用左肾静脉下控制腹主动脉后，切开腹主动脉逆行血栓内膜切除、腹主动脉-双股动脉人造血管旁路术的手术效果。方法在左肾静脉下控制腹主动脉，远侧纵行切开腹主动脉，清除管腔内血栓内膜，在阻断钳控制下，以大弯钳或刮匙或Fogarty导管等器械逆行做腹主动脉近侧端血栓内膜切除，腹主-股总动脉Y型人工血管旁路术。结果4例手术患者安全地渡过了围手术期，术后均得到随访，随访时间6—24个月，效果良好，其中1例行腹主动脉、股动脉、胭动脉序贯旁路的患者在术后8个月出现股胭动脉旁路处的人造血管血栓，行截肢术。结论手术是近肾腹主动脉闭塞的唯一合理选择，左肾静脉下控制腹主动脉后的腹主动脉逆行血栓内膜切除、腹主动脉双侧股动脉人造血管转流术是符合生理的术式，患者未出现脏器栓塞，症状明显改善，术后效果良好.

Diagnosis and Surgical Treatment of Juxta-Renal Aortic Occlusion

Objective To explore the feasibility of retrograding endarterectomy via a longitude incision of aortic and accomplishing aorta-bilateral femoral artery bypass grafting after effective control of aorta below for patients with juxta-renal aortic occlusion (JAO).Methods The abdominal aorta was effectively controlled below the left renal vein,and its distalis was longitudinally incised.After the local endarterectomy was carried out and the aortic was controlled by cross-clamps,the retrograded endarterectomy was made in the proximal of abdominal aorta with oval forceps,curettes and Fogarty catheters.Then a Y type aorta-femoral bypass grafting was completed.Results 4 patients lived all through perioperative period smoothly.Follow-up of 6~24 months showed excellent curative effect.Thrombosis was found at femoral popliteal bypass in 1 case after 8 months and accepted above the-knee amputations.This case was a patient with aortic femoral popliteal bypass.Conclusions Surgical treatment is a proper choice for JAO.The retrograding endarterectomy via a longitudinal incision of aortic and undergoing aorta-bilateral femoral artery bypass grafting after control of aorta below the left renal vein might be a more physiological and prior procedure.No complications were found such as organ embolism.The symptoms were effectively relieved.