复杂性近肾腹主动脉闭塞症的手术治疗
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林海E-mail:840338898@qq.com

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Surgical treatment of complex juxta-renal abdominal aortic occlusive disease
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    摘要:

    目的:探讨不同近肾腹主动脉闭塞和(或)合并有其他部位血管疾病的患者的合理手术方式。
    方法:回顾性分析手术治疗的17例近肾腹主动脉闭塞的患者的临床资料,其中6例伴有下肢动脉的重度狭窄或闭塞,5例伴肾动脉狭窄,2例伴有锁骨下动脉狭窄,1例同时伴有肾动脉的狭窄和一侧股浅动脉闭塞, 1例伴有胸主动脉瘤。手术方式有主-髂(股)动脉人工血管搭桥术(12例),腋-双股人工血管搭桥(4例),经双侧股动脉切开取拴+腔内支架成形术(1例),在合并有其他部位血管疾病处理方法有血管腔内球囊扩张+支架成形、股-腘动脉人工血管搭桥及动脉瘤切除人工血管置换术。
    结果:1例术后4 d死亡,其他16例未出现严重并发症。16例患者术后下肢缺血症状均得到明显改善,其中5例下肢静息痛症状消失,4例高血压患者血压较术前明显容易控制,2例肾功能不全患者术后肾功能恢复到正常水平,2例伴有头晕、上肢乏力症状患者术后症状消失。16例存活患者均获5~ 56个月随访,生存率高达94.1%,致残及严重血管并发症机率为6.3%。
    结论:针对近肾腹主动脉闭塞症和(或)合并有其他部位血管疾病患者制定合理的手术方式尤为重要,也是提高患者生存率及生存质量的关键。

    Abstract:

    Objective:To study the rational surgical approaches for patients with juxtarenal abdominal aortic occlusion, with or without combined vascular regions of the body.
    Methods:Clinical data of 17 patients with juxtarenal abdominal aortic occlusion admitted to our department form 2004—2008 were analyzed retrospectively.The 17 patients included 6 cases combined with severe arterial stenosis of lower extremity, 5 cases combined with renal arterial stenosis, 2 cases combined with subclavical arterial stenosis,1 case combined with renal  arterial stenosis and femoral arterial occlusion in one side,  and 1case combined with thoracic aortic aneurysm.Surgical approaches for the patients with juxtarenal abdominal aortic occlusion included aorto-iliac vascular prosthesis by-pass in 12 cases,axillary-double femoral vascular prosthesis by-pass in 4 cases, and bilateral femoral arteriotomy plus thrombus extraction in one case. The accompanying vascular disease in other vessels were treated by intravascular balloon dilatation and stent insertion, or by femoro-popliteal vascular prosthesis by-pass and aneurysmectomy plus prosthetic vascular replacement.
    Results:There was one death in this series. The other 16 cases did not have any severe complications.Lower limb ischemia symptoms was relieved in 16 cases; and 7 cases of lower limb rest pain, 4 cases with hypertension, 2 cases with impaired renal funotion, and 2 cases with dizziness were markedly improved postoperatively.
    Conclusions:It is very important that patients with juxtarenal abdominal aortic occlusion combined with vascular disease of other regions of the body should be treated by different surgical approaches, which is the key point to improve patients’survival rate and quality of life.

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林海| 王亮| 吕凯明| 洪翔| 路中江| 邱国煌.复杂性近肾腹主动脉闭塞症的手术治疗[J].中国普通外科杂志,2010,19(6):602-605.
DOI:10.7659/j. issn.1005-6947.2010.06.002

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  • 收稿日期:2010-03-02
  • 最后修改日期:2010-05-08
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  • 在线发布日期: 2010-06-15