腹主动脉瘤术中不同髂内动脉处理的疗效观察

目的：探讨腹主动脉瘤（AAA）术中结扎或是封闭髂内动脉（IIA）对患者疗效的影响。方法：回顾性分析2010年6月—2014年6月中南大学湘雅医院手术治疗的108例AAA患者临床资料，其中腔内修复61例，开放手术44例，杂交手术3例。44例开放手术中结扎双侧IIA 7例，结扎单侧IIA 8例；61例腔内修复术中封闭双侧IIA 3例，封闭单侧IIA 5例。结果：无术中死亡，围手术期30 d内有6例死亡均与处理IIA无关。开放手术结扎或腔内修复封闭双侧IIA的10例患者中，1例（1/10）出现直肠缺血症状，经过抗凝和扩血管治疗1个月后症状缓解；2例（2/10）出现术后一过性的臀肌疼痛，保守治疗后症状消失；均未出现间歇性跛行。开放手术结扎或是腔内修复封闭单侧IIA的13例患者中均未出现直肠缺血，臀肌疼痛或是间歇性跛行。结论：AAA患者术中结扎或是封闭单侧IIA对患者术后状况无明显影响；结扎或是封闭双侧IIA可能出现直肠缺血或是臀肌疼痛等盆腔缺血的表现，但可经保守治疗缓解。

Efficacy analysis of different methods of treatment of internal iliac artery during surgery for abdominal aortic aneurysm

Objective: To observe the outcome following exclusion of internal iliac artery (IIA) during operation of abdominal aortic aneurysm (AAA).Methods: The clinical data of 108 AAA patients undergoing surgical treatment in Xiangya Hospital form June 2010 to June 2014 were retrospectively analyzed. Of the patients, 44 cases were subjected to open surgery, 61 cases received endovascular aneurysm repair (EVAR) and 3 cases underwent hybrid surgery. Seven patients underwent bilateral IIA ligation and 8 patients underwent unilateral IIA ligation in those undergoing open surgery, and 3 patients underwent bilateral IIA coverage and 5 patients underwent unilateral IIA coverage in those undergoing EVAR.Results: No intraoperative death occurred, and 6 cases died within perioperative 30 d but none of them was due to the IIA treatment. Among the 10 patients undergoing open bilateral IIA ligation or endovascular bilateral IIA coverage, one case (1/10) developed symptoms of rectal ischemia that was alleviated after one-month of anticoagulation and vascular dilation therapy, and a short-period of gluteus pain occurred in two cases (2/10), which disappeared by conservative treatment; no intermittent claudication occurred. No symptoms such as rectal ischemia, gluteus pain or intermittent claudication occurred in any of the patients who underwent open unilateral IIA ligation or endovascular unilateral IIA coverage.Conclusion: During surgery for AAA, unilateral IIA ligation or coverage exerts no obvious influence on postoperative condition, whereas bilateral IIA ligation or coverage may cause the symptoms of pelvic ischemia such as rectal ischemia and gluteus pain that can be resolved by conservative treatment.