腹主动脉瘤破裂的外科急救(附19例报告)

目的 探讨腹主动脉瘤破裂的诊断、治疗及影响预后的因素。方法 回顾性分析2003年3月至2009年2月收治的19例肾动脉下腹主动脉瘤破裂患者的临床资料。男15例,女4例,50~82岁,平均64.7岁。所有患者均有突发剧烈腹痛及休克,8例腹部可扪及搏动性包块,2例有腹主动脉瘤病史。并存疾病中,原发性高血压7例,冠心病3例,慢性支气管炎1例。19例均行急诊手术治疗,根据术中情况采用肾动脉下腹主动脉钳夹阻断或腹主动脉腔内球囊阻断,控制出血后行人造血管移植术。随访12~48个月,平均（24±2）个月。结果 围术期因急性心肌梗死死亡1例,多器官功能衰竭死亡2例。早期并发症：4例发生急性肾功能不全,2例发生肺部感染,3例出现腹泻。术后30d后至随访终末无死亡,无吻合口假性动脉瘤、人工血管感染和血管内血栓形成等并发症发生。结论 尽早确诊,紧急手术控制出血,术后加强围手术期管理是降低腹主动脉瘤破裂死亡率的关键。

Experience of emergency surgery on ruptured abdominal aortic aneurysm(a report of 19 cases)

Objective    To explore  diagnosis, treatment and factors affecting the prognosis of ruptured abdominal aortic aneurysm（RAAA）. Methods    Between March 2003 and February 2009,  clinical data of 19 patients (15 males  4 females ; age range 50 82 years, mean age 64.7 years) with RAAA below the level of renal arteries treated with emergency surgery in Shandong Provincial Hospital were analyzed retrospectively. All of the patients were subjected to sudden acuteness bellyache and ensued shock . Among them,  2 cases had a history of AAA and 8 cases had pulsating abdominal masses.  Concomitant diseases included 7  primary hypertension, 3 coronary heart disease and 1 emphysema. All  the patients underwent emergency operation: The ruptures of the abdominal aorta below the level of renal arteries were obstructed by using clamp ring or transluminal balloon according to the conditions of each patient. The artificial vascular graft was taken after the hemorrhage were stopped. After the operation, every patient was followed up for an average of (24±2) months. Results    3 (15.8%) patients died within 30 days after the operation. The causes of death included acute myocardial infarction (1 case) and multiple organ failure (2 cases). Early complications consisted of acute renal failure (4 cases), lung infection (2 cases), and diarrhea (3 cases). During follow-up, no death, anastomotic false aneurysm, graft infection, intravascular thrombus formation or other complications ever occurred. Conclusion    Early diagnosis, emergency surgery to stop bleeding, intensive perioperative management  are the keys to reduce the mortality of RAAA.