摘要
目的探讨循环不稳定的破裂性腹主动脉瘤围手术期合并严重急性下肢缺血的处理及预后。方法回顾性分析中国医科大学附属第一医院血管甲状腺外科2002年6月至2012年6月行开放手术的46例循环不稳定的破裂性腹主动脉瘤患者临床资料，探讨合并严重下肢缺血患者的临床特点及处理方式。结果共46例临床资料完整的患者人选，平均年龄69岁，男37例，女9例，均行急诊腹主动脉瘤切除，Y型人工血管移植术，8例患者在术中或术后出现危及肢体存活的严重下肢缺血，其中2例术中另行人工血管一远端髂动脉搭桥术，2例行吻合口支架植入成形术，2例行Fogarty导管取栓＋置管溶栓术，1例单纯Fogarty导管取栓，1例溶栓抗凝保守治疗。8例患者中有5例最终因肢体坏死需行膝上截肢术（4例单侧，1例双侧），该5例患者均死亡，4例为多器官功能衰竭，1例为心源性猝死。下肢缺血组的处理难度及死亡率明显增高。结论对于破裂性腹主动脉瘤，术前往往来不及对下肢缺血作全面细致的评估，术中术后都面临着下肢动脉血栓形成或栓塞的威胁，一旦发生，处理难度极大。挽救生命和肢体的关键在于能否在第一时间发现并处理缺血。
Objective To explore the treatment and prognosis of critical limb ischemia during perioperative period of open surgery for ruptured abdominal aortic aneurysm （AAA）. Methods Retrospective reviews were conducted for the clinical data of unstable ruptured AAA patients with open repair at our hospital from June 2002 to June 2012 to examine the characteristics and treatment regimens for associated critical limb ischemia. Results A total of 46 unstable AAAs were enrolled. There were 37 males and 9 females with an average age of 69 years. All AAAs were repaired by a bifurcated polytetrafluoroethylene graft via a transperitoneal midline incision. Critical limb ischemia was found in 8 patients during or after the procedure. Treatments included additional graft-distal iliac artery bypass （ n = 2 ）, anastomotic stoma stenting （ n = 2 ）, Fogarty catheter embolectomy plus local thrombolysis （ n = 2 ）, Fogarty catheter embolectomy （ n = 1 ） and venous thrombolysis （ n = 1 ）. Lower limb necrosis developed in 5 patients （4 unilateral, 1 bilateral） and all of them died. Conclusion Open repair of ruptured AAA may be associated with a considerate morbidity of critical limb ischemia. Early reconstruction of blood flow improves the prognosis.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第9期653-655,共3页
National Medical Journal of China
关键词
主动脉瘤
腹
外科手术
下肢
缺血
Aortic aneurysm, abdominal
Surgical procedures, operative
Lower extremity
Ischemia
