187例肾下腹主动脉瘤的手术治疗经验

目的　总结肾下型腹主动脉瘤手术经验。方法　回顾性分析 1 992年 1月至 2 0 0 4年2月 1 87例择期行肾下型腹主动脉瘤切除术 (或同时切除髂动脉瘤 )的临床资料。结果　围手术期心梗死亡 1例 ,死亡率为 0 . 5 4 %。手术时间 3～ 6h ,平均 3 8h ;出血量 2 0 0～ 1 5 0 0ml,平均 4 70ml;输血量 0～ 1 5 0 0ml,平均 4 4 5ml。ICU停留时间 1 2～ 2 4h。围手术期并发症包括心力衰竭 1 7例 ,呼吸衰竭 8例 ,急性心肌梗死 2例 ,急性脑梗死 1例 ,急性肾功能衰竭 3例 ,无术后严重出血或失血性休克发生 ,无下肢动脉栓塞发生。术后 1、3、5年生存率分别为 97. 0 %、84. 6 %、78 . 3%,患者随访期间的死亡与腹主动脉瘤和手术无关。结论　瘤体直径不能作为手术指征。腹主动脉瘤手术的危险因素主要是高龄、严重的心肺疾患和肾功能不全等。手术切除腹主动脉瘤疗效是满意的。

Surgical experience on 187 cases undergoing open repair of the abdominal aortic aneurysms

Objective To summarize our surgical experience on 187 patients undergoing open repair of abdominal aortic aneurysms (AAAs). Methods Data of 187 patients with infrarenal AAA who were treated electively with open repair between January 1992 and February, 2004 were retrospectively reviewed. Results One patient (0.54%) died perioperatively due to ventricular premature beat, ventricular fibrillation 6 hours after. The mean duration of operative procedure was 3.8 hours. The mean blood loss was 445 ml. Perioperative complications included heart failure in 17 cases, respiratory failure in 8, acute myocardial infarction in 2, cerebral infarction in 1, and acute renal failure in 3. The 1? 3? 5-year survival rate was 97.0%? 84.6% and 78.3%, respectively. Conclusion The aneurysm diameter is not the absolute operative indication. Risk factors for open operation of AAA are old age, severe cardial, pulmonary diseases and renal desfunction. Open surgery is still the treatment of choice for AAA.