腹主动脉瘤破裂的处理及预后分析

目的探讨腹主动脉瘤破裂的处理及影响预后的主要因素。方法回顾性分析12年间收治的42例腹主动脉瘤破裂的临床资料。85．7％的患者术前行影像学检查确诊。36例行手术治疗,其中35例行腹主动脉瘤切除人工血管植入术,术中80％采用肾动脉下腹主动脉阻断, 14．3％采用膈下腹主动脉阻断,5．7％采用Foley尿管球囊阻断（2例）;1例行覆膜支架腔内隔绝术。结果围手术期死亡率45．24％。单因素统计分析表明在围手术期死亡者年龄（72．1±1．0）岁、合并疾病13例和术前收缩压（82±53）mm Hg;存活者年龄（61．5±17．0）岁、合并症7例、术前收缩压（82±28）mm Hg,之间差异有统计学意义（P〈0．05）,而性别、术前Hb、肌酐、瘤体直径和手术失血量则无显著差异（P〉0．05）。结论手术是治疗破裂腹主动脉瘤的惟一有效方法,高龄、合并其他疾病和休克提示预后不良。

Treatment and prognosis of ruptured abdominal aortic aneurysms

Objective To evaluate the management of ruptured abdominal aortic aneurysms (RAAA) and to analyze the prognostic factors. Methods The clinical data of 42 RAAA patients were analyzed retrospectively. Correct diagnosis was established by imaging studies in 36 patients preoperatively. Surgical reconstructions with aneurysm resection and graft interposition were performed in 35 cases and endovascular aneurysm repair in one case. Results Nineteen cases (45. 24% ) died in perioperative period. Age, concurrent diseases, chronic health status and preoperative systolic pressure were significantly related to perioperative mortality, while gender, hemoglobin, creatinine, diameter of aneurysm and blood loss were not significant prognostic factors. Conclusions Surgery is the only effective treatment for RAAA. Elder, or shock patient and patient with concurrent diseases had worse prognosis.