CAJ | 학술논문

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-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.
목적 탐토순배불은정적파렬성복주동맥류위수술기합병엄중급성하지결혈적처리급예후.방법 회고성분석중국의과대학부속제일의원혈관갑상선외과2002년6월지2012년6월행개방수술적46례순배불은정적파렬성복주동맥류환자림상자료,탐토합병엄중하지결혈환자적림상특점급처리방식.결과 공46례림상자료완정적환자인선,평균년령69세,남37례,녀9례,균행급진복주동맥류절제,Y형인공혈관이식술,8례환자재술중혹술후출현위급지체존활적엄중하지결혈,기중2례술중령행인공혈관-원단가동맥탑교술,2례행문합구지가식입성형술,2례행Fogarty도관취전+치관용전술,1례단순Fogarty도관취전,1례용전항응보수치료.8례환자중유5례최종인지체배사수행슬상절지술(4례단측,1례쌍측),해5례환자균사망,4례위다기관공능쇠갈,1례위심원성졸사.하지결혈조적처리난도급사망솔명현증고.결론 대우파렬성복주동맥류,술전왕왕래불급대하지결혈작전면세치적평고,술중술후도면림착하지동맥혈전형성혹전새적위협,일단발생,처리난도겁대.만구생명화지체적관건재우능부재제일시간발현병처리결혈.
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.