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[多学科军队医院腹主动脉瘤破裂的治疗]

[Treatment of rupture of abdominal aortic aneurism in multi-field military hospital].

作者信息

Beliakin S A, Obraztsov A V, Pinchuk O V, Kryzhov S N, Iamenskov B B, Bokachev R A, Tikhonov P A

出版信息

Voen Med Zh. 2013 Sep;334(9):35-9.

Abstract

For the last 5 years in the center of vascular surgery of Vishnevskiy 3rd Central Military Clinical Hospital 218 patients with abdominal aortic aneurism were treated, 96 planned surgical operations for abdominal aortic aneurism (post-operative mortality 3.1%) were performed. 11 patients underwent urgent surgical operation because of rupture of abdominal aortic aneurism. 1 of 11 patients died at the stage of laparotomy, the second patient died after clipping of ruptured aneurysm. In other 9 cases surgical operation was performed successfully. But 2 of 9 patients died in a few hours after surgery. In summary, 4 of 11 patients underwent surgical operation for rupture of abdominal aortic aneurism survived. The postoperative mortality was 63.6%. Authors gave an example of successful treatment of patient with rupture of abdominal aortic aneurism. It was concluded that successful treatment of rupture of abdominal aortic aneurism is possible only in case of well-run integration of different treatment and diagnostic departments. CT angiography is crucial for instrumental diagnostics of rupture of abdominal aortic aneurism. Successful surgical operation is impossible without organized blood supply service, refusion and donor blood. Artificial lung ventilation, extracorporal detoxication and adequate pharmacological supply help to avoid severe complications during the postoperative period, even in patients with associated pathology.

摘要

在维什涅夫斯基第三中央军事临床医院血管外科中心的过去5年里,共治疗了218例腹主动脉瘤患者,其中96例接受了腹主动脉瘤的计划性手术(术后死亡率为3.1%)。11例患者因腹主动脉瘤破裂接受了急诊手术。11例患者中有1例在剖腹手术阶段死亡,第2例患者在夹闭破裂动脉瘤后死亡。其他9例手术成功进行。但9例患者中有2例在术后数小时内死亡。综上所述,11例因腹主动脉瘤破裂接受手术的患者中有4例存活。术后死亡率为63.6%。作者给出了一例腹主动脉瘤破裂患者成功治疗的案例。得出的结论是,只有在不同治疗和诊断科室良好整合的情况下,腹主动脉瘤破裂才有可能得到成功治疗。CT血管造影对于腹主动脉瘤破裂的器械诊断至关重要。没有有组织的血液供应服务、输血和供血,成功的手术是不可能的。人工肺通气、体外解毒和充足的药物供应有助于避免术后严重并发症,即使是伴有相关病变的患者。

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