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感染性腹主动脉瘤--挑战与陷阱并存
感染性腹主动脉瘤(infectious abdominal aortic aneurysm,IAAA)是一种罕见而且病情凶险的外科疾病。由Osler于1885年首次报道[1],其发病率低,约占所有腹主动脉瘤(abdominal aortic aneurysm,AAA)的0.7%~3.0%,但病情凶险,死亡率可高达70%[2],死因主要为AAA破裂及脓毒血症。检索国内外文献多为个案或小宗例数的报道,因此相关诊治经验较少。本文总结国内外新研究进展结合临床经验,对该疾病进行总结论述。
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感染性腹主动脉瘤的诊疗现状及展望
感染性腹主动脉瘤(infected abdominal aortic aneurysm,IAAA)是腹主动脉瘤的一种特殊的类型,占全部腹主动脉瘤的0.7%~3%[1],在感染性动脉瘤中可占1%~3%[2],其病情凶险,死亡率居高不下。据文献报道,与IAAA破裂和脓毒血症主要相关的死亡率高达44%[3],早期诊治对疾病转归和为患者赢得生存几率至关重要。
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Background Percutaneous abdominal aortic aneurysm(AAA) repair has been previously described using the "preclose"technique and general endotrachial anesthesia (GA).
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腹主动脉瘤的药物治疗研究进展
1概述腹主动脉瘤(abdominal aortic aneurysm,AAA)是严重的致死性疾病之一,一旦瘤体破裂,死亡率高达90%以上[1];在所有疾病死亡原因中位列第13位.
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感染性腹主动脉瘤的治疗探讨
感染性腹主动脉瘤(infected abdominal aortic aneurysm, IAAA)发病率约占所有腹主动脉瘤的0.7%~3.0%[1],临床误诊率高、并发症多、预后差、治疗困难,主要致死原因为感染所致的动脉瘤破裂出血(包括动脉瘤-消化道瘘)及全身性感染并发症。
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国内破裂性腹主动脉瘤治疗结果(1997年~2012年)及治疗趋向
本报告统计国内近15年破裂性腹主动脉瘤(ruptured abdominal aortic aneurysm,RAAA)的治疗方法和治疗结果,以探讨对该病的合理治疗,并了解当前国内RAAA的总体诊治现状和发展趋向,思考对RAAA是否还有腔内治疗的发展空间.
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降低破裂腹主动脉瘤的死亡率
破裂腹主动脉瘤(rupture abdominal aortic aneurysm,rAAA)是一种少见而极其凶险的主动脉危急症。据国外文献报道,rAAA发病率为(1~21)/10万,其总体死亡率高达81%,32%左右发生在入院前,且在医院内尚未治疗的患者死亡率高达40%[1],所以迅速实施治疗或手术至关重要。目前rAAA的手术方式有开放和腔内治疗,孰优孰劣难有定论,实际上提高抢救成功率、降低死亡率是核心问题。本文就手术选择及围手术期处理做一阐述。
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球囊导尿管在腹主动脉瘤破裂手术救治中的应用
腹主动脉瘤破裂(ruptured abdominal aortic aneurysm,RAAA)来势凶险、手术难度大、死亡率高,已成为对血管外科医师的一个挑战.我科自2002年5月至2005年7月期间共收治RAAA患者10例,现报告如下.
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开放或血管腔内修复腹主动脉瘤21 178例的荟萃分析
目的 已有几个研究比较择期开放和血管腔内方法治疗腹主动脉瘤的预后,而结果并不一致.方法 进行随机效应meta分析对手术结果、术后并发症、30天死亡率和术后患者长期存活率进行比较.以优势比(ORs)、加权平均差异(WMDs)或者log风险比(HRs)等合适的方法来比较事件终点.结果 42个研究共21 178例患者(开放10 855例;血管腔内10 323例)被纳入.在择期手术组(20 715例),血管腔内方法的重症监护时间较短(WMD -36 h; P<0.001),术后总住院时间亦较短(WMD -5.4 d; P<0.001).心脏并发症(OR 1.76; P =0.002)和呼吸系统并发症(OR 4.01; P<0.001)在开放手术后更常见.在血管腔内组,30天死亡率较低(OR 0.46; P<0.001).血管腔内手术的远期动脉瘤相关死亡率也较低(HR 0.39; P<0.001).对于破裂性腹主动脉瘤(463例),这种微创手术的重症监护时间较短(WMD -100.4 h; P=0.005),30天死亡率也明显为低(OR 0.45; P=0.005).结论 血管腔内修复腹主动脉瘤在降低术后不良事件和30天死亡率等方面成效显著.对于更远期,其动脉瘤相关死亡率也明显降低,但总体死亡率没有降低.
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腹主动脉瘤破裂的诊治近况
随着医学的发展,择期腹主动脉瘤的治疗已取得了令人满意的效果,但腹主动脉瘤破裂(ruptured abdominal aortic aneurysm, RAAA)的救治却仍无重大突破.近期资料表明,开腹治疗腹主动脉瘤破裂的1个月内死亡率高达34.7%~50.5%,腔内介入治疗手术死亡率也达29.9%[1].Banke等[2]也调查发现即使在术后良好的监护治疗下,腹主动脉瘤破裂患者1个月内的死亡率也高达39%.Grant等[3]则通过对过去13年的资料统计,表明住院腹主动脉破裂患者死亡率仍维持不变,手术死亡率达37.8%,住院总死亡率达48.3%.但也有学者认为,近15年来,RAAA的救治率没有提高主要是因为手术患者的年龄也随之增高[4].本文就近年来RAAA的诊治作一综述.
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超声诊断真性腹主动脉瘤一例报告
1 临床资料患者,男性,71岁,因患高血压病21年、冠心病9年入我院疗养.入院3 d后来我科行常规超声查体.B超检查示:中重度脂肪肝,肝多发囊肿.当超声探头扫查至中上腹部时,于腹主动脉远段、肾动脉起始处下方,探及腹主动脉明显扩张呈梭形,扩张处大前后径约5.4 cm,其相邻动脉段内径2.2 cm,二者比值为2.4.
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腹主动脉瘤切除术后病人的体位护理
腹主动脉瘤(abdominal aortic aneurysm,AAA)是一种常见的动脉扩张性疾病,其发病率占所有动脉瘤的第一位[1].大宗病例的长期随访统计发现,AAA确诊后未经手术者的5年生存率约19%,其中多数死于AAA破裂,因此手术是该病目前唯一有效的治疗方法[2].实施AAA切除术后的病人按书上常规体位法护理需要卧床2周或3周,此体位容易引起焦虑、压疮、肺部感染、胃肠蠕动减慢、下肢深静脉血栓形成等术后并发症.本文对AAA切除术后的体位护理进行了对比研究,现报告如下.
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中国血管腔内外科技术发展历程20年介入物理疗法的激光技术、血管腔内支架发展技术、支架材料学改性技术、提高术后患者的生活质量
The endovascular surgery in China has been developing from none to a few, from a few to many, from primary to refinement,from blind to directional, and it is expecting to grow even rapidly as "spring bamboo after a timely rain" in which "science is the first motive force" and a consistent diligence and endeavor putting into it from vascular scientists and practitioners has been playing a distinctively important role. It has experienced a hard initiation and developing process. Describing here is mainly the development of endolumianl vascular surgery for major vein and artery, i.e., the vena cava and the aorta, however it was still from research and practice of the medium-sized vessels. Until now, we have treated more than 137 cases. The total number of patients with aortic dissection treated by endografting should be more than 1 000. The endoluminal treatment, including the hybrid or semi-interventional method for treating aortic dissection is very likely to have a particularly better future in comparison to the treatment for those with the infra-renal abdominal aortic aneurysm in which requires, unlikely the surgery for handling aortic dissections with long segmental involvement of the aorta,less surgical demanding. It is predicted that the distinctively difference we have had now between China and the Western World in term of the incidence of abdominal aortic aneurysm and aortic dissections and their related treatment would be gradually disappeared in the future. The endoluminal treatment for treating greater vessel disorders has less mortality and postoperative complications, such as hyperplagia, stoke or cerebral deficits, paralysis,etc., less rehabilitation is required and thus has a fruitful future.
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基质金属蛋白酶-9在腹主动脉瘤研究中的进展
腹主动脉瘤(abdominal aortic aneurysm,AAA)是一种严重威胁人类生命的疾病,其发生发展与患者年龄、动脉粥样硬化程度和动脉壁中结缔组织的破坏有关.统计显示目前AAA的发病率约为1%~2%,且随着人口的老龄化,发病率还在不断增加.