16例腹主动脉瘤合并消化系统疾病的手术治疗

目的探讨腹主动脉瘤合并需外科手术的消化系统疾病的外科治疗方法。方法回顾性分析16例腹主动脉瘤合并消化系统疾病进行手术治疗患者的临床资料,总结处理经验。腹主动脉瘤与消化系统疾病同期手术12例（同时行胆囊切除术5例,结肠癌根治术7例）,腹主动脉瘤腔内治疗后行结肠癌根治术2例、食道下段癌根治术1例,先行胃癌根治术后再行腹主动脉瘤手术1例。结果发生食道胃吻合口瘘1例,术后第2天死亡。胃瘫1例,经保守治疗30d后恢复。14例存活8～60个月,无人工血管感染,无血管支架内漏,无肿瘤复发。结论腹主动脉瘤与消化系统疾病并存,只要全身和局部情况允许,应争取同期手术,反之应分期手术,合适病例在腹主动脉瘤腔内治疗后,再行消化系统疾病手术,这是一种安全、有效的方法。

Surgical Treatment of Abdominal Aortic Aneurysm Complicated with Digestive System Disease: a Report of 16 Cases

Objective To approach the surgical treatment strategy of abdominal aortic aneurysm complicated with digestive system disease.Methods The clinical data of 16 cases with abdominal aortic aneurysm complicated with digestive system diseases were analyzed retrospectively and summarized.There were 12 cases of one-stage operation for abdominal aortic aneurysm complicated with digestive system disease（5 cases of cholecystectomy and 7 cases of radical resection of colon cancer）,2 cases of radical resection of colon cancer after intracavitary therapy of abdominal aortic aneurysm,1 case of radical resection of low esophageal,and 1 case of abdominal aortic aneurysm surgery after radical resection of gastric cancer.Results 1 case was with esophagus and stomach anastomotic fistula and died on the next day after surgery;1 case with gastric paralysis and recovered after 30 days＇ conservative therapy.Another 14 cases survived 8 to 60 months without artificial vascular infection,endoleak of vascular stents and cancer recurrent.Conclusion One-stage operation should be carried out in the patients with abdominal aortic aneurysm complicated with digestive system disease while the whole and local conditions of the patients permitted.Otherwise,staging surgery should be considered.It is safe and in effect to do the digestive system diseases operation after intracavitary therapy of abdominal aortic aneurysm.