腹主动脉瘤腔内隔绝术后缺血性结肠炎的诊治

为探讨腹主动脉瘤术后并发缺血性结肠炎的诊断和治疗，作者回顾性分析了1997年3月－2000年1月间施行的腹主动脉瘤腔内隔绝术40例，其中30例保留双侧髂内动脉（双侧组），10例保留单侧髂内动脉或移植物远端固定于双侧髂外动脉、手术重建单侧髂内动脉（单侧组）。统计两组患者的术后肠蠕动恢复时间及肠道并发症。两组患者中仅双侧组1例于术后第28天始出现持续性中下腹隐痛，经纤维结肠镜检查确诊为缺血性结肠炎，经CTA发现术后继发双侧髂内动脉闭塞，经扩血管、促进侧支循环建立等保守治疗缓解；其余患者除并发其他并发症的3例外，均于术后第二天恢复其普食及排气排便。提示腔内隔绝术中保留单侧髂内动脉可避免术后缺血性结肠炎的发生；继发于术后双侧髂内动脉阻塞的慢性缺血性结肠炎，在肠镜随访观察下进行有效的保守治疗是首选治疗方法。

DIAGNOSIS AND MANAGEMENT OF COLONIC ISCHEMIA AFTER ENDOVASCULAR GRAFT EXCLUSION FOR ABDOMINAL AORTIC ANEURYSM

Colonic ischemia is a well documented complication of abdominal aortic reconstruction. In this retrospective study of abdominal aortic aneurysm patients undergone endovascular graft exclusion, the incidence and management of this complication were investigated. From Mar 1997 to Apr 2000,among the 40 patients who received elective endovascular graft exclusion for,infrarenal abdominal aortic aneurysm the bilateral hypogastric artery was retained in 30 patients, the unilateral hyogastric artery was retained in 10 patients. One patient had lower abdominal pain on the 28th day after operation, CTA showed the bilateral hypogastric artery occlusion, the symptoms were relieved after drug treatment. Retaining unilateral hypogastric artery can prevent the colonic ischemia after endovascular graft exclusion for abdominal aortic aneurysm, the chronic colonic ischemia secondary to bilateral hypogastric artery occlusion can be relieved by effective drug treatment.