多发结核性腹主动脉瘤一例

结核性主动脉瘤相当少见,自1895年以来文献报道仅50余例,平均发病年龄50±16岁,其中88%为假性动脉瘤,且多为单发,而多发性主动脉假性动脉瘤仅4例.治疗结核性主动脉假性动脉瘤必须是抗结核治疗与手术治疗相结合,一经确诊,应及早手术治疗,瘤体的大小不是决定是否需要手术的决定因素.本例患者为70岁,男性,确诊肺结核后经不规范抗结核治疗后出现间断腹痛,经血管造影诊断为多发结核性腹主动脉假性动脉瘤, 在腹主动脉腹腔干开口上方可见最大径约5 cm×6 cm的假性动脉癌,基底约3.3 cm;在腹主动脉肠系膜上动脉水平背侧及肾动脉腹侧可见各有1个假性动脉瘤,直径均约1 cm.在抗结核治疗与控制感染同时,一期手术时对已破裂的较大之腹主动脉假性动脉瘤行腔内隔绝术;在二期手术前,腹主动脉较小之动脉瘤即发生破裂,但患者家属放弃治疗,最终患者死于消化道大出血.

A case of multiple tuberculous aneurysm of the abdominal aorta

Tuberculous aneurysm of the aorta is a very rare disorder. There have been only 50 reported cases of tuberculous aneurysm since 1895 till now, of which 88% were false aneurysms with majority being single in number. And only four were found to have multiple tuberculous aneurysms. The mean ages of the patients were 50+/-16 years. Treatment of tuberculous aortic aneurysm must be a combined medical and surgical approach. Once tuberculous aneurysm is identified, surgery must be performed promptly. The size of the aneurysm does not influence the need for surgery. A 70-year-old male with intermittent episodes of abdominal pain after receiving an inappropriate antitubercular therapy for pulmonary tuberculosis was diagnosed as multiple false tubercular aneurysm of abdominal aorta. An aneurysm of base 3.3 cm and greatest diameter 5 cm x 6 cm was seen just above the opening of Coeliac trunk. Also at the dorsal aspect of abdominal aorta and superior mesenteric artery junction and ventral aspect of renal artery false aneurysms were seen, each with the size of 1 cm in diameter. Apart from antitubercular and antimicrobial treatment, first line surgery Endovascular Exclusion of Abdominal Aortic Aneurysm was performed for ruptured false abdominal aortic aneurysm. Even before the second line surgery, smaller abdominal aortic aneurysms got ruptured and the patient's party gave up further treatment. Finally the patient died of gastrointestinal haemorrhage.