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腹主动脉瘤破裂患者的急救及护理对策

【摘要】 目的 总结对腹主动脉瘤破裂患者的急救措施及护理对策。 方法 回顾分析2004年1月-2008年2月收治的11例腹主动脉瘤破裂患者抢救及护理过程。 结果 6例患者治愈出院，5例死亡，其中术中失血性休克死亡1例，术后消化道大出血及多功能器官衰竭死亡2例，放弃治疗出院后死亡2例，存活率为54.5%。 结论 通过对腹主动脉瘤破裂患者采取及时有效的抢救配合及护理措施，有效地提高了手术的成功率及生存率。

Surgical Treatment for Ruptured Abdominal Aortic Aneurysm（ Report of 20 Cases）

Objective　To explore the diagnosis and treatment for ruptured abdominal aortic aneurysm （RAAA）. Methods　The clinical data of 20 patients with RAAA from January 2000 to December 2010 were analyzed retrospectively．Results　There were 18 males and 2 females．The age was 31-82 years with an average 65.4 years．All the patients were abdominal pain and （or） back pain．Eleven cases had low blood pressure or shock．Seven cases had a history of abdominal aortic aneurysm．All the cases were accurately diagnosed by CTA，Doppler ultrasonography or operation．Nineteen cases were treated by conventional operation，1 by endovascular aortic repair．Survival of 16 cases recovered smoothly. Perioperative death occurred in 4 cases，mortality rate was 20% in 20 patients with RAAA．The causes of death included circulatory failure in 1 case and multiple organ dysfunction syndrome in 3 cases．Conclusions　Surgery treatment is an effective treatment for RAAA．Early diagnosis and urgent surgical repair are crucial to reduce the mortality of RAAA．

Endovascular Repair of Abdominal Aorta Using Branched Stent Graft in A Novel In Vitro Vascular Model

ObjectiveTo evaluate the feasibility and security of endovascular repair of abdominal aorta using branched stent graft in a novel in vitro vascular model. MethodsThe branched stent graft for the abdominal aorta was designed. The novel in vitro vascular model was established to test this stent graft. Attempts were made to optimize the procedure of stent graft and to evaluate the feasibility of this device. The branched stent graft for abdominal aorta was tested by a novel in vitro vascular model. The number of stent graft released and expanded was recorded respectively. The pressure and situation of branch vessels were assessed before and after stent graft released. The endoleak during releasing process was observed by digital subtraction angiography (DSA). ResultsThe stent graft was successfully deployed in the novel in vitro vascular model. The releasing process was all properly achieved (100%, 30/30). The pressure changes of branch vessels were no statistical significances (P > 0.05) between before and after stent graft released. The stent grafts were well landed, and were fully expanded and properly positioned by DSA. No endoleak occurred. ConclusionThe branched stent graft for abdominal aorta in a novel in vitro vascular model is safe and feasible.

人工血管重建术治疗腹主动脉瘤

目的 总结人工血管重建术治疗肾动脉平面以下腹主动脉瘤的临床经验。 方法 对38例肾动脉平面以下的腹主动脉瘤行人工血管重建手术,其中9例采用直桶形人工血管，29例采用“人”字形分叉人工血管。分别采用保留后壁或完全切断瘤颈的方法吻合近心端，对于远心端根据病情分别吻合在腹主动脉末端、髂总动脉或髂外动脉。重建髂内动脉8支，结扎髂内动脉3支。依据术中测压结果重建肠系膜下动脉11支,缝扎21支。 结果 术后死亡1例,于手术后6d发生结肠破裂，14d死于感染性休克; 二次开腹止血1例，37例患者痊愈出院，并分别随访3个月~2.5年，1例于术后2年死于心肌梗死。其余患者预后良好，无人工血管内血栓形成、吻合口假性动脉瘤和移植血管感染等中、远期并发症发生。 结论 人工血管重建术是腹主动脉瘤最彻底、有效的治疗方法，正确选择手术适应证、良好的手术设计、手术技巧以及重视并发症的防治是保证手术成功的重要因素。

Applications capture technology in larger abdominal aortic aneurysm surgery performed during endovascular repair of abdominal aortic aneurysm

Objective To summarize the clinical experience of capture technology in the large diameter of abdominal aortic aneurysm in endovascular repair of abdominal aortic aneurysm(EVAR). Methods We retrospectively analyzed clinical data of 6 patients with abdominal aortic aneurysm (maximum diameter of 6.0 cm or bigger) in our hospital between July 2013 and May 2014.There were 3 males and 3 females at age of 76.2(73–81) years. Two patients of ruptured abdominal aortic aneurysm, in EVAR, established orbit using the capture technology successfully. Results The capture technology made the thread through the proximal tumor neck smoothly, successful repaired. One patient of rupture of abdominal aortic aneurysm was dead after 10 hours. One patient was lost to follow-up. Four patients were followed up for 3 to 11 months. The four patients had not occurred bracket displacement, internal leakage, thrombosis, or other serious complications. Conclusion For the patients with larger abdominal aortic aneurysm, capture technology may be used to the thread through the proximal tumor neck, to build a convey or track easily, to shorten the operation time, to improve the success rate of surgery.

Intraoperative ultrasound during endovascular aneurysm repair for infrarenal aortic aneurysms with internal iliac artery aneurysm

Objective To discuss feasibility and effectivity of intraoperative ultrasound (US) during endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm. Methods A radiographic contrast nephropathy patient of abdominal aortic aneurysm and left internal iliac artery aneurysm was treated by EVAR without iodine contrast media assisted by US. Then summarized the data of this patient. Results The precise placement of the stent-graft was performed for abdominal aortic aneurysm. The left internal iliac artery aneurysm was successfully treatment with the stent-graft and coils. Intraoperative Ⅱ type endoleak from inferior mesenteric artery and Ⅰ b type endoleak from right iliac stent were identified by using US. The operative duration was 120 min and the blood loss was only 20 mL. Ⅱ type endoleak was still detected and the Ⅰ b type of endoleak was loss on postoperative a week. Conclusion Intraoperative US-assisted EVAR in patients with infrarenal abdominal aortic aneurysm represents a new option for intraoperative visualization of aortoiliac segments required as proximal or distal fixation zones and identification of endoleaks, especially in those patients with contraindications for usage of iodine-containing contrast agents.

3D打印技术辅助复杂瘤颈腹主动脉瘤腔内治疗：附1例报道

目的探讨3D打印技术对复杂瘤颈腹主动脉瘤腔内治疗术前评估的可行性和有效性。 方法获取严重扭曲瘤颈的腹主动脉瘤CT数据，3D打印腹腔干以下腹主动脉和双侧髂总、髂内外动脉，并分析3D打印模型术前评估的效果。 结果3D打印模型能够术前预测严重扭曲瘤颈的腹主动脉瘤支架释放前后的形态改变情况，并可指导手术方案的选择。 结论3D打印技术尤其适用于复杂解剖条件腹主动脉瘤的腔内治疗评估。

Application of different molecular imaging techniques in predicting the progress of abdominal aortic aneurysm

Abdominal aortic aneurysm (AAA) is a common lethal aortic disease in clinical practice. At present, the imaging diagnostic methods used for AAA mainly include Doppler ultrasound, computed tomography and magnetic resonance imaging (MRI), but these methods can only observe the morphological changes of the aorta. These techniques used for the risk assessment of aneurysms, such as aneurysm rupture have some certain limitations. With the continuous development of molecular imaging technology and the further understanding of the pathogenesis of AAA, positron emission tomography (PET), molecular MRI and single photon emission computed tomography (SPECT) techniques can be used to observe the pathological changes of the AAA and assess the risk of rupture from cell and molecular level. In this paper, the latest application of PET, molecular MRI, SPECT in the risk assessment was discussed.

以截瘫为首发症状的青年急性腹主动脉栓塞一例

腹主动脉球囊阻断下骶骨肿瘤切除重建术

目的 总结在腹主动脉球囊阻断下行骶骨肿瘤切除重建的手术方法及疗效。 方法 2006 年2 月－2008 年12 月，对8 例骶骨肿瘤采用在腹主动脉球囊阻断下切除肿瘤。男5 例，女3 例；年龄32 ～ 63 岁。脊索瘤4 例，巨细胞瘤2 例，神经鞘瘤1 例，神经纤维瘤1 例。累及节段：S3 4 例，S4 2 例。肿瘤大小6 cm × 4 cm ～ 12 cm × 10 cm。病程6 个月～ 2 年。 结果 术中出血平均1 250 mL，术后引流平均500 mL。2 例术后出现切口皮肤坏死，1 例因脑脊液漏致切口不愈，均经对症处理后愈合，其余切口均Ⅰ期愈合。术后患者均获随访，随访时间12 ～ 18 个月。未见肿瘤复治低位骶骨肿瘤的首选方法，腹主动脉球囊阻断技术可有效减少术中出血，降低神经损伤的风险，为骶骨肿瘤的完整切除提供有利条件。