Umeda Yukio, Mori Yoshio, Takagi Hisato, Iwata Hisashi, Matsuno Yukihiro, Hirose Hajime
First Department of Surgery, Gifu University School of Medicine, 40 Tsukasa-machi, Gifu 500-8705, Japan.
Heart Vessels. 2003 Mar;18(1):7-11. doi: 10.1007/s003800300001.
Abdominal aortic aneurysm repair in patients undergoing chronic hemodialysis presents several surgical difficulties due to tissue fragility, accelerated atherosclerosis, and calcification of the aorta. In addition to these surgical procedure-related problems, anemia, electrolyte abnormalities, bleeding tendency, and susceptibility to infection were also critical issues in perioperative management. The aim of this study was to examine the surgical outcome of abdominal aortic aneurysm repair in patients undergoing chronic hemodialysis. Between January 1988 and August 2001, six patients undergoing chronic hemodialysis underwent repair of an abdominal aortic aneurysm. There were five males and one female, and the mean age was 65 years. Two of the six patients had bilateral common iliac artery aneurysms in addition to the abdominal aortic aneurysm. At the time of abdominal aortic aneurysm repair, the duration of hemodialysis had ranged from 3 to 109 months, with a mean of 34 months. All patients underwent hemodialysis on the day prior to the abdominal aortic aneurysm repair operation. The first postoperative hemodialysis was scheduled to be performed on the day after operation or later. The mean duration of operation was 291 min. Blood transfusion was required in all patients. The first postoperative hemodialysis was performed between the first and third postoperative days. Postoperative complications were: ileus in one, and atrial fibrillation and blue toe syndrome just after operation in one. There was no hospital death. The follow-up period was 56 months. One patient died of lingual cancer at 102 months after operation. Five patients are alive. Abdominal aortic aneurysm repair can be done in patients on chronic hemodialysis with an acceptable early and long-term outcome.
由于组织脆弱、动脉粥样硬化加速以及主动脉钙化，接受慢性血液透析的患者进行腹主动脉瘤修复存在若干手术困难。除了这些与手术操作相关的问题外，贫血、电解质异常、出血倾向和感染易感性也是围手术期管理中的关键问题。本研究的目的是检查接受慢性血液透析的患者进行腹主动脉瘤修复的手术结果。1988年1月至2001年8月期间，6例接受慢性血液透析的患者接受了腹主动脉瘤修复。其中男性5例，女性1例，平均年龄65岁。6例患者中有2例除腹主动脉瘤外还患有双侧髂总动脉瘤。在进行腹主动脉瘤修复时，血液透析时间为3至109个月，平均34个月。所有患者在腹主动脉瘤修复手术前一天进行血液透析。术后首次血液透析计划在术后第一天或之后进行。平均手术时间为291分钟。所有患者均需要输血。术后首次血液透析在术后第一天至第三天进行。术后并发症为：1例肠梗阻，1例术后即刻出现房颤和蓝趾综合征。无住院死亡病例。随访期为56个月。1例患者在术后102个月死于舌癌。5例患者存活。接受慢性血液透析的患者可以进行腹主动脉瘤修复，早期和长期结果均可接受。
