中国实用外科杂志

中国实用外科杂志 ›› 2012, Vol. 32 ›› Issue (12): 973-975.

• 院士论坛 •    下一篇

肾动脉平面以下腹主动脉瘤腔内治疗指征商榷

汪忠镐， 胡志伟   

  1. 首都医科大学附属宣武医院血管外科研究所，北京100053
  • 出版日期:2012-12-01 发布日期:2012-11-29

  • Online:2012-12-01 Published:2012-11-29

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摘要：

肾动脉平面以下腹主动脉瘤（IRAAA）不同于胸腹主动脉瘤和发生在肾动脉以上腹主动脉瘤，只要有合适而安全的腔内疗法就应立即积极应用，尤其是年老、多病、全身状态差的IRAAA病人，这样可避免巨大的手术风险。但腔内疗法存在内漏、装置耐久性、需要长期影像学随访和可能的反复再次矫正等问题，而手术治疗是一种已被充分确立的可靠耐久的治疗方法。 因此，当解剖上有困难时不必一定要坚持采用微创法治疗，也不必降低手术指征。对小的主动脉瘤以致主动脉扩张者应进行微创治疗；对于相对年轻、健康或体力劳动者，采用何种方法为宜是一个值得探讨的问题。

关键词: 腹主动脉瘤, 血管腔内治疗, 肾动脉平面

Abstract:

Concern about indications for endovascular treatment of infra-renal abdominal aortic aneurysm        WANG Zhong-gao, HU Zhi-wei. Vascular Institute and Xuan Wu Hospital, Capital Medical University, Beijing100053, China
Corresponding author：WANG Zhong-gao，E-mail：zhonggaowang@yahoo.com
Abstract    Unlike the thoracoabdominal aneurysm or supra-renal abdominal aortic aneurysm, in which so long as there is a reliable and safe endografting remedy emerging, it will be greatly appreciated and immediately applied, since surgery for them is major with high operative risk. In contrast, surgical resection and reconstruction for the infra-renal aortic aneurysm (IRAAA) is a well-defined surgery with durability. The emergence of the endoluminal technique to treat IRAAA is fantastic for those with elder, poor general statue, co-morbidity, etc. However, it has disadvantage of endoleak, durability, requiring long-term surveillance, and more request for postoperative corrections. Thus it is not necessary to insist on applying endograf to deal those with anatomy difficulty (example giving) and to lower criteria to treat those with small size aneurysms, even dilatation of the aorta. For relatively young, healthy and physical labor taking person, which method is better fixed, seems worth considering.

Key words: abdominal aortic aneurysm, endovascular treatment, rend artery plane