腹主动脉瘤的治疗

目的 探讨腹主动脉瘤(AAA)的治疗方法。方法 回顾性分析26例AAA的临床资料。结果 26例中夹层动脉瘤3例，真性动脉瘤21例，动脉瘤破裂后再形成的假性动脉瘤1例，动脉瘤穿破十二指肠空肠曲形成腹主动脉肠瘘1例。病变累及肾动脉平面以上者3例，肾动脉平面以下者23例：病变仅累及腹主动脉者4例，病变除累及腹主动脉外，尚合并有单侧或双侧髂总动脉瘤者／2例，合并双侧髂总动脉瘤及一例或双侧髂内动脉瘤者5例，合并一侧髂总、髂内、髂外动脉瘤1例，合并有双侧髂总、髂内、髂外动脉瘤1例。施行紧急手术治疗3例，择期手术治疗14例，施行支架型人工血管腔内微创治疗7例，未手术2例。术后发生并发症3例，无瘫痪、下肢动脉栓塞等发生。术中及术后30d死亡率为3．8％(1例)。支架型人工血管治疗的7例无漏血、移位等并发症发生，均痊愈出院。22例随访3个月至4年，均存活良好。结论 AAA的腔内血管外科治疗具有创伤小，术石恢复快，并发症少等优点，有条件行支架型人工血管作腔内治疗的应优先考虑腔内治疗，传统手术方法在技巧等方面的改进有利于提高手术的成功率，并能为不具备腔内治疗条件的患者解除疾患。

Treatment of the abdominal aortic aneurysms

Objective To explore the management of abdominal aortic aneurysms (AAAs) .Methods The clinical data of 26 patients with AAAs were reviewed retrospectively. Results In the 26 cases,dissection and true aneurysms were found in 3 and 21 respectively, 1 AAA ruptured followed by a false aneurysm formation,and 1 involved duodenojajunary curve to form an aorto intestinal fistul. The lesions involved the renal artery in 3, below renal artery in 23; AAA extended to both common iliac arteries in 12, to both common iliac arteries and one or both internal iliac artery in 5,to both or one common and ,lexternal.internal arteries in 2; Emergency operation was done on 3 patients, elective operation on 14, endoluminal treatment in 7 and conservative treatment in 2. Three cases developed mild postoperative complications. Operative mortality was 3.8% ( 1 case ). 22 patients were followed up for 3 month to 4 years, and living well. Conclusions Endolumianal treatment is the first choice for the AAAs patients . However, the traditional operation is still very important and effective for the patient who can not be treated by endoluminal treatment,especially with improvement of the surgical skills.