Tjon-A-Meeuw L, Bollinger A
Departement für Innere Medizin, Universitätsspital Zürich.
Schweiz Med Wochenschr. 1991 May 11;121(19):683-92.
Atherosclerotic abdominal aortic aneurysms are found in about 4% of all men aged over 65 years. The most severe complication of the abdominal aortic aneurysm is rupture. The probability of rupture depends upon the diameter of the aneurysm. The chance of rupture is 30% within 2 years in aneurysms with a maximum diameter of more than 5 cm. Preoperative evaluation includes clinical examination and abdominal ultrasonography. Depending on the results, aortography and/or computed tomography are required. When the diameter is less than 5 cm in an asymptomatic patient, conservative management is indicated provided that clinical tests and ultrasonography are performed on a regular basis. The mean increase of diameter varies between 0.2 and 0.4 cm/year. All aneurysms with a diameter of more than 5 cm should be treated by implantation of a dacron graft. Symptomatic aneurysms should, independently of the diameter, be considered an emergency situation and resected immediately. Patients with ruptured aneurysms have a poor prognosis; only 40-60% of these patients reach the hospital and approximately 50% of them die despite immediate surgery. A special subgroup is the so called inflammatory abdominal aortic aneurysm. Characteristic findings of this entity are increased wall thickness and retroperitoneal fibrosis. The indications for resection are the same as for the atherosclerotic aneurysm. If management is conservative, treatment with corticosteroids is useful.
在所有65岁以上的男性中，约4%的人患有动脉粥样硬化性腹主动脉瘤。腹主动脉瘤最严重的并发症是破裂。破裂的可能性取决于动脉瘤的直径。最大直径超过5 cm的动脉瘤在2年内破裂的几率为30%。术前评估包括临床检查和腹部超声检查。根据检查结果，可能需要进行主动脉造影和/或计算机断层扫描。对于无症状且直径小于5 cm的患者，若定期进行临床检查和超声检查，则可采取保守治疗。动脉瘤直径的年平均增长幅度在0.2至0.4 cm之间。所有直径超过5 cm的动脉瘤均应通过植入涤纶移植物进行治疗。有症状的动脉瘤，无论其直径大小，均应视为紧急情况并立即进行切除。动脉瘤破裂的患者预后较差；这些患者中只有40%至60%能抵达医院，尽管立即进行了手术，但仍有约50%的患者死亡。一个特殊的亚组是所谓的炎性腹主动脉瘤。该病症的特征性表现为管壁增厚和腹膜后纤维化。其切除指征与动脉粥样硬化性动脉瘤相同。若采取保守治疗，使用皮质类固醇进行治疗会有帮助。
