Darling R C, Cordero J A, Chang B B, Shah D M, Paty P S, Lloyd W E, Leather R P
Vascular Surgery Section, Albany Medical College, New York 12208, USA.
Cardiovasc Surg. 1996 Dec;4(6):720-3. doi: 10.1016/s0967-2109(96)00034-8.
Over the past two decades, the mortality rate for elective repair of infrarenal abdominal aortic aneurysms has improved to an acceptable level (< 5%). However, surgical results of ruptured abdominal aortic aneurysms have remained fairly constant with about 50% in hospital mortality rates. Growing experience with the use of the left retroperitoneal exposure for elective aortic surgery allowed the authors to extend the use of this technique to the repair of ruptured abdominal aortic aneurysm. The extended left retroperitoneal approach using a posterolateral exposure through the 10th intercostal space allowed the surgeon expeditiously and reliably to obtain supraceliac aortic control by dividing the left crus of the diaphragm in all patients. In total, 104 aortic replacements were performed for ruptured abdominal aortic aneurysm during the past 7 years. Of these patients, 87 were men and 17 women; mean(range) age was 72(52-95) years. Hemodynamic instability (as defined by a systolic blood pressure of < 90 mmHg) was present before surgery in 41% (43/104) of patients. The operative mortality rate was 27.9% (29/104). Preoperative hemodynamic instability, time of operative delay and aortic cross-clamp time did not correlate with operative mortality. The median duration of intensive care unit stay was 4 (range 1-60) days and hospital stay 11 (range 6-175) days. The results of this series identified that a change in the operative technique for the repair of ruptured abdominal aortic aneurysm beneficially affected patient survival. The authors suggest that expeditious supraceliac control without thoracotomy is an excellent alternative and offers an advantage in the surgical management of ruptured abdominal aortic aneurysm.
在过去二十年中，肾下腹主动脉瘤择期修复的死亡率已降至可接受水平（<5%）。然而，破裂性腹主动脉瘤的手术结果一直相当稳定，住院死亡率约为50%。随着在择期主动脉手术中使用左腹膜后入路的经验不断积累，作者将该技术扩展应用于破裂性腹主动脉瘤的修复。通过第10肋间间隙采用后外侧入路的扩展左腹膜后手术方法，使外科医生能够在所有患者中迅速且可靠地通过切开膈肌左脚获得腹腔干上方主动脉控制。在过去7年中，共对104例破裂性腹主动脉瘤进行了主动脉置换手术。其中男性87例，女性17例；平均（范围）年龄为72（52 - 95）岁。41%（43/104）的患者术前存在血流动力学不稳定（定义为收缩压<90 mmHg）。手术死亡率为27.9%（29/104）。术前血流动力学不稳定、手术延迟时间和主动脉阻断时间与手术死亡率无关。重症监护病房停留时间中位数为4（范围1 - 60）天，住院时间为11（范围6 - 175）天。该系列研究结果表明，破裂性腹主动脉瘤修复手术技术的改变对患者生存率产生了有益影响。作者认为，无需开胸即可迅速实现腹腔干上方控制是一种极佳的选择，在破裂性腹主动脉瘤的外科治疗中具有优势。
