破裂性腹主动脉瘤的治疗

目的探讨破裂性腹主动脉瘤急诊救治的治疗经验。方法回顾性研究2002年5月-2013年7月救治的36例破裂性腹主动脉瘤患者的临床资料。其中25例合并高血压病，21例合并慢性阻塞性肺疾病。33例采取急诊开腹主动脉人工血管置换术；3例采取主动脉覆膜支架腔内修复术，其中1例中转开腹手术治疗。结果术后33例存活，另外3例死亡，死亡原因包括1例失血性休克和心功能衰竭，1例术中心跳骤停，1例术后多器官功能衰竭，围手术期病死率为8．3％。术后随访3～61个月，未发生人工血管感染等手术相关并发症及死亡病例。结论积极的手术治疗是提高破裂性腹主动脉瘤患者救治成功率的关键，早期明确诊断，手术中快速有效控制近端瘤颈血流，完善围手术期治疗能有效降低病死率。

Surgical treatment of ruptured abdominal aortic aneurysm

Objective To evaluate surgical management of ruptured abdominal aortic aneurysm （RAAA）. Methods Clinical data of 36 RAAA patients undergoing emergent graft replacement or endovascular aortic repair （EVAR） from May 2002 to July 2013 were retrospectively analyzed. 25 and 21 patients were associated with hypertension and chronic obstructive pulmonary disease respectively. 33 patients were treated with graft replacement. 3 patients received endovascular treatment and 1 patient converted to open surgery. Results Perioperative death occurred in 3 patients including severe hemorrhagic shock in 1 patient, cardiac arrest in 1 patient and multiple organ failure in 1 patient. During follow up for 3 to 61 months, no operaion related complication, such as artificial graft infection happened. Conclusions Emergent operation including open surgery and EVAR is crucial for RAAA treatment. Early diagnosis, excellent operative techniques and effective perioperative management are measures conducive to lowering the mortality rate of RAAA.