您的位置:山东大学 -> 科技期刊社 -> 《山东大学学报(医学版)》

山东大学学报 (医学版) ›› 2024, Vol. 62 ›› Issue (9): 26-29.doi: 10.6040/j.issn.1671-7554.0.2024.0341

• 主动脉疾病基础与临床研究进展专刊—研究进展 • 上一篇    下一篇

腹主动脉瘤的开放手术

史潇兮,辛世杰   

  1. 中国医科大学附属第一医院血管外科/甲状腺外科, 辽宁 沈阳 110001
  • 发布日期:2024-10-10
  • 通讯作者: 辛世杰. E-mail:sjxin@cmu.edu.cn
  • 基金资助:
    国家自然科学基金(81974049)

Open aortic repair of abdominal aortic aneurysm

SHI Xiaoxi, XIN Shijie   

  1. Department of Vascular and Thyroid Surgery, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
  • Published:2024-10-10

摘要: 腹主动脉瘤(abdominal aortic aneurysm, AAA)是血管外科的常见疾病,传统开放手术(open aortic repair, OAR)或腔内修复(endovascular aortic repair, EVAR)是仅有的有效治疗手段。OAR在20世纪50至90年代达到鼎盛,因其本身的创伤性、技术的复杂性、EVAR技术的迅猛发展等原因,应用已逐渐减少,但在基础研究、年轻患者及感染性AAA等情况中,OAR的作用仍然不可替代。本文回顾OAR的历史和现状,分析其优势和劣势,并讨论术中关键技术要点及并发症的处理,总结在EVAR时代OAR所扮演的角色和地位。

关键词: 腹主动脉瘤, 开放手术, 手术入路, 阻断, 重建, 术中并发症

Abstract: Abdominal aortic aneurysm(AAA)is a common disease in vascular surgery. Traditional open aortic repair(OAR)or endovascular aortic repair(EVAR)is the only effective treatment. OAR reached its peak between 1950s and 1990s, and due to its trauma, technical complexity and the rapid development of EVAR technology, the application of OAR has gradually decreased. However, the role of OAR is still irreplaceable in basic research, young patients and mycotic AAA. This study reviewed the history and current situation of OAR, analyzed its advantages and disadvantages, discussed the key points of intraoperative techniques and the management of complications, and summarized the role and position played by OAR in the EVAR era.

Key words: Abdominal aortic aneurysm, Open aortic repair, Surgical approach, Block, Reconstruction, Intraoperative complications

中图分类号: 

  • R543.1+6
[1] Johnston KW, Rutherford RB, Tilson MD, et al. Suggested standards for reporting on arterial aneurysms[J]. J Vasc Surg, 1991, 13(3): 452-458.
[2] Sakalihasan N, Michel JB, Katsargyris A, et al. Abdominal aortic aneurysms[J]. Nat Rev Dis Primers, 2018, 4(1): 34.
[3] Golledge J, Muller J, Daugherty A, et al. Abdominal aortic aneurysm: pathogenesis and implications for management[J]. Arterioscler Thromb Vasc Biol, 2006, 26(12): 2605-2613.
[4] Golledge J. Abdominal aortic aneurysm: update on pathogenesis and medical treatments[J]. Nat Rev Cardiol, 2019, 16(4): 225-242.
[5] Sampson UKA, Norman PE, et al. Global and regional burden of aortic dissection and aneurysms: mortality trends in 21 world regions, 1990 to 2010[J]. Glob Heart, 2014, 9(1): 171-180.
[6] Friedman SG. The 50th anniversary of abdominal aortic reconstruction[J]. J Vasc Surg, 2001, 33(4): 895-898.
[7] Blakemore AH, Jr Voorhees AB. The use of tubes constructed from vinyon N cloth in bridging arterial defects; experimental and clinical[J]. Ann Surg, 1954, 140(3): 324-334.
[8] 董雨亭, 段志泉, 谷树人, 等. 腹及胸腹主动脉瘤的外科治疗(附9例报告)[J]. 实用外科杂志, 1988, 8(9): 471-473. DONG Yuting, DUAN Zhiquan, GU Shuren, et al. Surgical treatment of abdominal and thoracoabdominal aortic aneurysm(report of 9 cases)[J]. Chinese Journal of Practical Surgery, 1988, 8(9): 471-473.
[9] Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms[J]. Ann Vasc Surg, 1991, 5(6): 491-499.
[10] Rouwet EV, Torsello G, de Vries JP, et al. Final results of the prospective European trial of the Endurant stent graft for endovascular abdominal aortic aneurysm repair[J]. Eur J Vasc Endovasc Surg, 2011, 42(4): 489-497.
[11] Boyle JR, Mao J, Beck AW, et al. Variation in intact abdominal aortic aneurysm repair outcomes by country: analysis of international consortium of vascular registries 2010-2016[J]. J Vasc Surg, 2021, 74(2): 679.
[12] Patel R, Sweeting MJ, Powell JT, et al. EVAR trial investigators. Endovascular versus open repair of abdominal aortic aneurysm in 15-years follow-up of the UK endovascular aneurysm repair trial 1(EVAR trial 1): a randomised controlled trial[J]. Lancet, 2016, 388(10058): 2366-2374.
[13] Antoniou GA, Antoniou SA, Torella F. Editors choice-endovascular vs. open repair for abdominal aortic aneurysm: systematic review and meta-analysis of updated peri-operative and long term data of randomised controlled trials[J]. Eur J Vasc Endovasc Surg, 2020, 59(3): 385-397.
[14] Chang DC, Parina RP, Wilson SE. Survival after endovascular vs open aortic aneurysm repairs[J]. JAMA Surg, 2015, 150(12): 1160-1166.
[15] Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm[J]. J Vasc Surg, 2018, 67(1): 2-77.
[16] Wanhainen A, Verzini F, Van Herzeele I, et al. Editors choice-European society for vascular surgery(ESVS)2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms[J]. Eur J Vasc Endovasc Surg, 2019, 57(1): 8-93.
[17] Abdominal aortic aneurysm: diagnosis and management[M]. London: National Institute for Health and Care Excellence(NICE), 2020. https://www.ncbi.nlm.nih.gov/books/NBK556921/.
[18] Ogino H, Iida O, Akutsu K, et al. JCS/JSCVS/JATS/JSVS 2020 guideline on diagnosis and treatment of aortic aneurysm and aortic dissection[J]. Circ J, 2023, 87(10): 1410-1621.
[19] 辛世杰, 张珈玮, 张健, 等. 单中心近10年腹主动脉瘤1 246例流行病学研究[J]. 中国实用外科杂志, 2021, 41(12): 1384-1393. XIN Shijie, ZHANG Jiawei, ZHANG Jian, et al. Epidemiological study of 1,246 cases of abdominal aortic aneurysm from a single center in the last 10 years[J]. Chinese Journal of Practical Surgery, 2021, 41(12): 1384-1393.
[20] Wang L, Xin SJ, Song Z, et al. Left renal vein division during open surgery of abdominal aortic disease: a propensity score-matched case-control study[J]. Eur J Vasc Endovasc Surg, 2013, 46(2): 227-231.
[21] Sicard GA, Reilly JM, Rubin BG, et al. Transabdominal versus retroperitoneal incision for abdominal aortic surgery: report of a prospective randomized trial[J]. J Vasc Surg, 1995, 21(2): 174-181;discussion 181-183.
[22] Welch HJ. Retroperitoneal approach for aortic surgery: is it worth it?[J]. Cardiovasc Surg, 2002, 10(2): 185.
[23] Robertson L, Nandhra S. Laparoscopic surgery for elective abdominal aortic aneurysm repair[J]. Cochrane Database Syst Rev, 2017(5). doi:10.1002/14651858.cd012302.
[24] Rusch R, Hoffmann G, Rusch M, et al. Robotic-assisted abdominal aortic surgery: evidence and techniques[J]. J Robot Surg, 2022, 16(6): 1265-1271.
[25] Charlton-Ouw KM, Sandhu HK, Huang G, et al. Reinfection after resection and revascularization of infected infrarenal abdominal aortic grafts[J]. J Vasc Surg, 2014, 59(3): 684-692.
[26] Oderich GS, Bower TC, Hofer J, et al. In situ rifampin-soaked grafts with omental coverage and antibiotic suppression are durable with low reinfection rates in patients with aortic graft enteric erosion or fistula[J]. J Vasc Surg, 2011, 53(1): 99-106, 107.
[27] Oda T, Minatoya K, Kobayashi J, et al. Prosthetic vascular graft infection through a Median sternotomy: a multicentre review[J]. Interact Cardiovasc Thorac Surg, 2015, 20(6): 701-706.
[1] 梁晨,姚丽娟,吕龙飞,唐泽,秦达,崔有斌,余孝淇. 三维重建联合CT引导下穿刺定位在微创治疗肺磨玻璃结节中的应用[J]. 山东大学学报 (医学版), 2026, 64(5): 74-82.
[2] 王皓正,张文雄. Q热伴胸腹主动脉瘤支架植入术后感染1例并文献复习[J]. 山东大学学报 (医学版), 2026, 64(1): 126-130.
[3] 徐瑞泽,王金兰, 罗清馨,徐朝珂,吕明阅,张硕,严鲁宁,胡锡峰,赵青波,朱高培,李磊, 薛付忠. 冠状动脉血运重建术对再发急性冠状动脉综合征的风险[J]. 山东大学学报 (医学版), 2025, 63(8): 103-110.
[4] 张蕾,潘叶,李家根,赵红. Hughes改良瓣修复大面积下睑全层缺损的临床效果[J]. 山东大学学报 (医学版), 2025, 63(7): 37-43.
[5] 国科,陈绪军,郑宝石,施超,黄克力,曹勇,陈军,吴东凯,张晓慎,罗俊辉,申林,莫绪明,杨岷,王晓武,雷印胜,田茂州,王振东,孟自力,孙忠东,李有金,陆辉辉,孟春营,高峰,陈黔苏,郭能瑞,柳德斌,张楠,林宇,陈文生,宋保国,方智,王海晨,廖晓波,徐朝军. 快通道拔管在全动脉冠脉旁路移植术的多中心临床效果[J]. 山东大学学报 (医学版), 2025, 63(5): 26-32.
[6] 王建旭,彭晓辉,丰浩田,安森博,董恣豪,黄子帅,刘喆,杨光. 应用内支撑技术辅助膝关节前交叉韧带全内重建术近期疗效观察[J]. 山东大学学报 (医学版), 2025, 63(3): 22-27.
[7] 杨建平,管圣,戈小虎. 利福平浸泡移植物治疗布鲁氏菌感染的主/髂动脉瘤的临床经验[J]. 山东大学学报 (医学版), 2025, 63(12): 17-25.
[8] 卫任,郭伟. 腹主动脉瘤腔内治疗现状[J]. 山东大学学报 (医学版), 2024, 62(9): 13-18.
[9] 高健峰,李方达,吴亮霖,曾嵘,郑月宏. 免疫性疾病相关主动脉病变诊疗进展[J]. 山东大学学报 (医学版), 2024, 62(9): 30-35.
[10] 霍正坤,孔祥骞,吴学君. 感染性主动脉瘤诊疗进展[J]. 山东大学学报 (医学版), 2024, 62(9): 42-48.
[11] 周永康,孙境,张帅,钱向阳. 胸腹主动脉瘤开放修复脊髓保护策略的研究进展[J]. 山东大学学报 (医学版), 2024, 62(9): 49-54.
[12] 范立彬,张鸿坤. 腹主动脉瘤腔内修复术后Ⅱ型内漏的预防及治疗进展[J]. 山东大学学报 (医学版), 2024, 62(9): 55-60.
[13] 牛帅,吴学君. 铁死亡在腹主动脉瘤中的研究进展[J]. 山东大学学报 (医学版), 2024, 62(9): 74-79.
[14] 孙境,张帅,齐红霞,李远,周永康,胡可鉴,钱向阳. 常温自身动脉转流内脏优先策略在胸腹主动脉置换手术中的脊髓保护作用[J]. 山东大学学报 (医学版), 2024, 62(9): 80-85.
[15] 杜国栋, 仇鹏, 刘俊超, 杨心蕊, 吴小雨, 崔超毅, 秦金保, 赵振, 叶开创, 刘光, 刘晓兵, 殷敏毅, 王瑞华, 陆信武. 激光原位开窗全腔内修复累及弓部主动脉夹层的临床结果及支架选择标准的单中心经验[J]. 山东大学学报 (医学版), 2024, 62(9): 86-92.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!