Lagneau P, Delaisement C, Regimbeau J M
Service de Chirurgie Vasculaire, Hôpital Saint Michel, Paris.
J Mal Vasc. 1996;21 Suppl A:48-52.
We compared retrospectively the immediate and mid-term outcome in 203 operations for AAA performed at the Saint-Michel Hospital in the vascular surgery department. Two groups of patients were treated either with a tube graft or with a Dacron bifurcated graft. In our experience, the tube was prefered when there were no haemodynamically significant stenosis or aneurysmal dilatations in the iliac arteries. Tube implantation was shorter and caused less haemorrhage (p < 0.01), but post-operative mortality and morbidity was not significantly different. Patients with bifurcated graft had late vascular complications requiring reoperation more often. Most were anastomotic false-aneurysms. Three patients with a tube developed iliac lesions requiring an aorto-femoral or aorto-bifemoral graft. Cure of an AAA with a tube graft is the choice treatment in patients free of severe iliac lesions or an aneurysmal bifurcation. The risk of subsequent iliac lesions requiring reoperation is low.
我们回顾性比较了圣米歇尔医院血管外科进行的203例腹主动脉瘤手术的近期和中期结果。两组患者分别接受了管状移植物或涤纶分叉移植物治疗。根据我们的经验，当髂动脉不存在血流动力学上显著的狭窄或动脉瘤样扩张时，优先选择管状移植物。管状移植物植入时间更短，出血更少（p < 0.01），但术后死亡率和发病率无显著差异。接受分叉移植物的患者更常出现需要再次手术的晚期血管并发症。大多数是吻合口假性动脉瘤。3例接受管状移植物的患者出现髂部病变，需要进行主动脉-股动脉或主动脉-双股动脉移植。对于没有严重髂部病变或动脉瘤样分叉的患者，使用管状移植物治愈腹主动脉瘤是首选治疗方法。后续出现需要再次手术的髂部病变的风险较低。
