随着外科技术和围手术期治疗水平日益提高，腹主动脉瘤择期手术治疗死亡率已控制在5%以内［1，2］，但破裂腹主动脉瘤（ruptured abdominal aortic aneurysm,RAAA）的死亡率一直在40%～70%，如果包括尚未到达医院的RAAA患者，死亡率可达80%～90%，RAAA被美国列为第13位死亡原因［2~4］。目前，及时准确的诊断和快速有效的外科治疗仍是降低RAAA死亡率的关键。......
ObjectiveTo review retrospectively our experience of the diagnosis and surgical treatment in patients with abdominal aortic aneurysm(AAA).MethodsThe diagnosis and surgical treatment in 72 patients 〔62 men, 10 women; mean age (67.5±9.3) years)〕 with AAA from January 1995 to February 2004 were analyzed. Fifty-eight patients with infrarenal AAA and 2 patients with suprarenal AAA underwent elective graft replacement operation; 12 patients with ruptured AAA underwent urgent graft replacement operation. ResultsFiftyeight patients with infrarenal AAA and 2 patients with suprarenal AAA were cured and 2 patients with infrarenal AAA died of multiple organ failure after elective graft replacement operation, the 30day mortality rate in patients with infrarenal AAA after elective operation was 3.45%. Seven patients were cured and 5 patients died of multiple organ failure after urgent graft replacement operation, the 30-day mortality rate was 41.67%. ConclusionThe elective graft replacement operation in patients with AAA is a safe and effective surgical approach under the improvement of surgical technique and management of perioperative period.
目的交流腹主动脉瘤的诊断和外科治疗方法。方法对1991年2月至2002年7月我院外科治疗的30例肾下型腹主动脉瘤的临床资料进行回顾性分析。结果数字减影血管造影术诊断1例，MRI诊断2例，其余27例均经CT确诊。该30例中，腹主动脉瘤破裂6例，行急诊手术，死亡2例（死亡率33.3%）； 24例未破裂者中， 22例行腹主动脉瘤切除和原位人造血管移植术，术后死亡2例（死亡率9.1%），另2例行腹主动脉瘤腔内人造血管移植术。结论及早术前诊断，恰当地选择手术时机、手术方式及正确的围手术期处理是提高手术成功率，减少术后并发症和死亡率的关键。
Objective To explore the effect, operational essential, and clinical meaning of transilluminated powered phlebectomy for patients with varicose vein of the lower extremity. Methods In the study, 255 patients with 363 lower extremities of varicose vein in our hospital between May 2006 and November 2009 were treated by transilluminated powered phlebectomy. According to revised clinical etiology anatomic and pathophysiological classification system (CEAP), there were 104 limbs in C2, 53 limbs in C3, 155 limbs in C4, 34 limbs in C5, and 17 limbs in C6. The patients were followed up to observe postoperative complications. Results All varicose vein labeled before operation were resected. Surgical time was (100±20) min in unilateral lower extremity and (147±19) min in bilateral lower extremities. Total 221 patients (302 lower extremities) were followed up in 4 to 46 months, median follow up time was 24.5 months. Total 167 cases (247 lower extremities) had accepted the operation more than 1 year, 154 cases (229 lower extremities) in which were followed up. In the 229 lower extremities above, recurrences occurred in 11 extremities, small amounts of residual small varices were observed in 2 extremities, the recurrence rate was 5.68% （13/229）. Twenty-one limbs with ulcer were healing in 3 to 6 weeks after operation. Postoperative complications: there was paresthesias or pain of ankle area in 16 limbs, which was improved in 3 to 6 months after physical therapy; there was ecchymosis of skin of leg in 112 limbs, which disappeared in 3 to 5 weeks after operation; there was light edema in 37 limbs, which disappeared in 1 to 2 weeks after operation; there was local hematoma in 2 limbs, incision light infection in 5 limbs, skin and subcutaneous tissue necrosis above medial malleolus in one limb, and back of knee popliteal skin lesion in 2 limbs, which were all cured by the symptomatic treatment. Conclusions Surgical treatment of varicose veins is actually the combination of various surgical procedures. Varicose vein extraction using transilluminated powered phlebectomy is safe, efficacious, and cosmetically satisfactory.