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肾下腹主动脉瘤治疗后发生的缺血性结肠炎:来自一家三级医疗中心的结果。

Ischemic colitis following infrarenal abdominal aortic aneurysm treatment: Results from a tertiary medical center.

作者信息

Aday Ulas, Gundes Ebubekir, Cetin Durmus Ali, Ciyiltepe Huseyin, Senger Aziz Serkan, Gulmez Selcuk, Akbulut Mustafa, Polat Erdal

机构信息

Department of Gastroenterological Surgery, Kartal Kosuyolu High Speciality and Training Hospital, Istanbul, Turkey.

Department of Cardiovascular Surgery, Kartal Kosuyolu High Speciality and Training Hospital, Istanbul, Turkey.

出版信息

North Clin Istanb. 2018 Sep;5(3):221-226. doi: 10.14744/nci.2017.80774.

Abstract

OBJECTIVE

The aim of this study was to investigate the effects of ruptured aneurysm on morbidity and mortality in patients with ischemic colitis (IC) and resection following infrarenal abdominal aortic aneurysms (AAA) surgery.

METHODS

Between January 2012 and December 2016, patients who underwent resection for ischemic colitis in our clinic were retrospectively reviewed. Data on the ruptured condition of the aneurysm, the emergency or elective form of aneurysm surgery, treatment method for the aneurysm (EVAR-open) were obtained. The patients were compared and divided into two groups as those with ruptured aneurysm and those without.

RESULTS

A total of 275 infrarenal AAA cases were treated by the cardiovascular surgery clinic between January 2012 and December 2016. Fourteen patients (5%) developed ischemic colitis requiring resection. Four (1.8%) patients with EVAR and 10 (17.5%) patients with open surgery were operated because of IC. No statistically significant difference was observed between the two groups in terms of demographic data and surgical procedures. The intergroup comparison did not reveal any statistically significant difference among gastrointestinal (GIS) symptoms, the time period until surgery, the involved colon segment, and the surgical procedures performed. The mortality rate in ruptured AAA group was 83.3%, while it was 62.5% in the non-ruptured AAA group. In spite of the fact that the mortality rate was high in the ruptured group, it was not statistically significant (p=0.393).

CONCLUSION

IC is a complication of AAA surgery with a high mortality rate. Rupture in abdominal aortic aneurysm increasing mortality in IC patients. This complication with a high mortality rate following open AAA surgery should be noted by surgeons and we believe that the liberal utilization of laparotomy and early intervention in suspected cases will decrease mortality rates.

摘要

目的

本研究旨在探讨破裂性动脉瘤对缺血性结肠炎(IC)患者发病率和死亡率的影响,以及肾下腹主动脉瘤(AAA)手术后的结肠切除术情况。

方法

回顾性分析2012年1月至2016年12月期间在我院接受缺血性结肠炎切除术的患者。获取动脉瘤破裂情况、动脉瘤手术的急诊或择期形式、动脉瘤治疗方法(腔内修复术-开放手术)等数据。将患者分为破裂性动脉瘤组和非破裂性动脉瘤组进行比较。

结果

2012年1月至2016年12月期间,心血管外科门诊共治疗275例肾下腹主动脉瘤患者。14例(5%)患者发生缺血性结肠炎需要行结肠切除术。因缺血性结肠炎行手术治疗的患者中,4例(1.8%)接受腔内修复术,10例(17.5%)接受开放手术。两组在人口统计学数据和手术方式方面无统计学显著差异。组间比较未发现胃肠道(GIS)症状、手术前时间、受累结肠段及所行手术方式之间存在统计学显著差异。破裂性腹主动脉瘤组的死亡率为83.3%,非破裂性腹主动脉瘤组为62.5%。尽管破裂组死亡率较高,但无统计学显著差异(p = 0.393)。

结论

缺血性结肠炎是腹主动脉瘤手术的一种并发症,死亡率较高。腹主动脉瘤破裂会增加缺血性结肠炎患者的死亡率。外科医生应注意这种开放腹主动脉瘤手术后死亡率较高的并发症,我们认为在疑似病例中广泛采用剖腹手术和早期干预将降低死亡率。

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Open Repair of AAA in a High Volume Center.大容量中心腹主动脉瘤的开放修复术
World J Surg. 2017 Mar;41(3):884-891. doi: 10.1007/s00268-016-3788-3.
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Ischemic colitis: the ABCs of diagnosis and surgical management.缺血性结肠炎:诊断与外科治疗要点。
J Visc Surg. 2013 Feb;150(1):19-28. doi: 10.1016/j.jviscsurg.2013.01.002. Epub 2013 Feb 20.
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Ischemic colitis: who will survive?缺血性结肠炎:谁能幸存?
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