Ishibe R, Maruko M, Tabata D, Toyohira H, Honbo K, Iwamura H, Nishimura M
Department of Surgery and Cardiovascular Surgery, Minamikyushu Chuou National Hospital, Kagoshima, Japan.
Nihon Geka Gakkai Zasshi. 1988 Feb;89(2):302-5.
A successful emergency operation for a 75-year-old man with aorto-caval fistula secondary to rupture of the abdominal aortic aneurysm is reported. A definite diagnosis of aorto-caval fistula was made by echography with characteristic engorgement of the caval vein. Clinical signs and symptoms characterized by lung edema, sudden onset, and circulatory collapse were also noticeable. In the operation, the fistula was closed via inside of the aneurysm with several mattress sutures following control of aortic flow and opening of the aneurysm. Back-flow of the blood through the fistula was readily controlled by finger tip. The aneurysm was replaced conventionally by a vascular prosthesis. There might be several suitable surgical selection available properly to individual case. No delay in surgical treatment depending on definite diagnosis by echography in such urgent condition should be stressed.
报道了一例针对一名75岁男性因腹主动脉瘤破裂继发主动脉腔静脉瘘的成功急诊手术。通过超声心动图发现腔静脉特征性充血，从而明确诊断为主动脉腔静脉瘘。以肺水肿、突发和循环衰竭为特征的临床体征和症状也很明显。手术中，在控制主动脉血流并打开动脉瘤后，通过在动脉瘤内部用数根褥式缝线封闭瘘口。用指尖很容易控制通过瘘口的血液回流。传统上用血管假体替换动脉瘤。针对个别病例可能有几种合适的手术选择。应强调在这种紧急情况下，不应因依赖超声心动图的明确诊断而延误手术治疗。
