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首页> 美国卫生研究院文献>Springer Open Choice >Lesson learned from early and long-term results of 327 cases of coexisting surgical abdominal diseases and aortic aneurysms treated in open and endovascular surgery
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Lesson learned from early and long-term results of 327 cases of coexisting surgical abdominal diseases and aortic aneurysms treated in open and endovascular surgery

机译：从327例开放和腔内手术并存的腹部外科疾病和主动脉瘤并存的早期和长期结果中获得的教训

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Patients with abdominal aortic aneurysm (AAA) frequently have other abdominal pathologies of surgical interest (other diseases, OD). Out of 1,375 elective open aortic replacements for AAA, 315 cases with OD were subdivided in Group 1 (82 patients with “clean wound” OD) and Group 2 (233 patients with “clean-contaminated wound” OD). The results of the sub-groups in which OD was treated at the same time as AAA were analysed (1a, 66 cases and 2a, 86 cases) and compared with OD not treated at the same time as AAA (1b, 16 cases and 2b, 147 cases). EVAR was done in 12 patients with a infrarenal AAA and concomitant abdominal disease. In this group post-operative complications occured in two patients (endoleaks) and no sign of endograft infection was developed. Mean follow-up was 36 months. Mortality was 0% in Group 1a, 1b, 2b and 5.8% in Group 2a. In Group 1a there were one haemoperitoneum, one ischaemic colitis and one graft infection. In Group 1b there were 4 nefrectomies for renal carcinoma and three emergency hernia repairs within 18 months from AAA operation. In Group 2a the follow-up was uneventful. In Group 2b there was no acute complication of OD and 57.2% of patients were subsequently operated for OD. In the EVAR group the 30-day and late mortality rates were 0 and 25%, respectively and all deaths were cancer-related. Contemporary correction of OD in open surgery for AAA should be performed in clean wound cases, while clean-contaminated operations can be done only in selected cases. EVAR is a valid alternative technique to open vascular surgery for the concomitant treatment of aortic aneurysms and abdominal pathologies.
机译：患有腹主动脉瘤（AAA）的患者经常有其他需要手术治疗的腹部病变（其他疾病，OD）。在AAA的1375例选择性开放性主动脉替代物中，将OD 315例细分为第1组（82例“清洁伤口” OD）和第2组（233例“清洁污染伤口” OD）。分析了与AAA同时治疗OD的亚组的结果（1a，66例和2a，86例），并与未与AAA同时治疗的OD进行了比较（1b，16例和2b） （147例）。在12例肾下AAA并发腹部疾病的患者中进行了EVAR。在该组中，两名患者发生了术后并发症（内漏），并且未出现移植物感染的迹象。平均随访时间为36个月。 1a，1b，2b组的死亡率为0％，2a组的死亡率为5.8％。在第1a组中，有1例腹膜炎，1例缺血性结肠炎和1例移植物感染。在AAA手术后的18个月内，第1b组中有4例肾癌肾小球切除术和3例紧急疝气修补术。在第2a组中，随访情况良好。在第2b组中，没有OD的急性并发症，随后有57.2％的患者接受了OD手术。在EVAR组，30天和晚期死亡率分别为0％和25％，所有死亡均与癌症有关。在AAA的开放手术中，当代的OD校正应在干净的伤口病例中进行，而仅在特定情况下才可以进行干净污染的手术。 EVAR是一种开放性血管手术的有效替代技术，可同时治疗主动脉瘤和腹​​部病变。

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