Gouny P, Bensenane J, Leschi J P, Cheynel-Hocquet C, Sezeur A, Gallot D, Malafosse M, Nussaume O
Service de Chirurgie Thoracique et Vasculaire, Hôpital Rothschild, Paris.
Chirurgie. 1994;120(8):431-8.
An association of an aneurysm of the abdominal aorta and a lesion of the colon raises an important question as to the correct sequence to follow. A simultaneous operation raises the major risk of infection and most authors prefer a sequential approach, treating either the aneurysm or the lesion of the colon first depending on the initial clinical situation or complications. In our first patient, both pathologies were known before surgery and simultaneous procedures were deliberately programmed. In the second case, both lesions were complicated and required simultaneous cure. In the third case, both were recognized before surgery and a sequential approach was followed--colon then abdominal aorta. In the fourth case, the colon disease was complicated and responded to medical treatment; three months later surgery was performed on the aneurysm followed by a colectomy two months later. A review of the literature and an analysis of our four cases offer a means of developing a management strategy for patients with an aneurysm of the abdominal aorta associated with a lesion of the colon.
腹主动脉瘤与结肠病变并存引发了一个关于正确治疗顺序的重要问题。同时进行手术会增加感染的重大风险，大多数作者倾向于采用分期手术的方法，根据初始临床情况或并发症，先治疗动脉瘤或结肠病变。在我们的首例患者中，两种病变在手术前就已明确，且特意安排了同期手术。在第二例中，两种病变均出现并发症，需要同时治愈。在第三例中，两种病变在手术前就已确诊，采用了分期手术的方法——先处理结肠，然后处理腹主动脉。在第四例中，结肠疾病出现并发症且经药物治疗有效；三个月后对动脉瘤进行了手术，两个月后进行了结肠切除术。对文献的回顾以及对我们这四例病例的分析为制定腹主动脉瘤合并结肠病变患者的管理策略提供了一种方法。
