Lacquet J P, Lacroix H, Nevelsteen A, Suy R
Department of Vascular Surgery, Gasthuisberg University Hospital, Leuven, Belgium.
Acta Chir Belg. 1997 Dec;97(6):286-92.
The purpose of this study is to review our experience with the surgical treatment of 110 patients with an inflammatory abdominal aortic aneurysm (IAAA). Furthermore, we focus especially on 37 ureteral obstructions.
Between 1978 and 1996 we treated 110 patients for an IAAA. It concerned 101 men and nine women with mean age of 66.8 years. Emergency surgery was performed in 32 patients (13 ruptures) and elective surgery in 78 patients (only 23 asymptomatic). The IAAA diagnosis was made by CT scan preoperatively in 40% of the patients. Compression of 37 ureters in 23 patients (14 bilateral, 9 unilateral) was noticed and ureteral stenting was performed preoperatively in nine patients (12 ureters). The surgical approach was median laparotomy (88 patients) or retroperitoneal approach (21 patients). One patient was treated with an endovascular Min-Tec Stentor aortic graft by femoral approach. Suprarenal clamping was necessary in 44 patients. Ureterolysis of 23 ureters was performed. Three peroperative iatrogenic lesions were successfully treated intraoperatively.
Fatal complications occurred in nine patients (8%), five patients after urgent surgery and four patients after elective surgery, all of them related to technical problems. Non fatal complications occurred in 22 patients, renal insufficiency was most important in ten patients (two permanent dialysis). The mean follow-up was 4.5 years (range, 0.5 to 15 years). Late survival was 68% at 5 years and 42% after 10 years. Seven patients presented late graft related complications, one fatal. In 14 surviving patients with 21 ureterolysed ureters, one needed a nefrectomy and one a bilateral Boari-plasty. In eight surviving patients with 11 stented ureters, one patient needed a small bowel interposition for ureteral stricture. After CT evaluation, all ureteral stents were removed 3 to 6 months after surgery.
本研究旨在回顾我们对110例炎性腹主动脉瘤（IAAA）患者进行手术治疗的经验。此外，我们特别关注37例输尿管梗阻情况。
1978年至1996年间，我们对110例IAAA患者进行了治疗。其中男性101例，女性9例，平均年龄66.8岁。32例患者（13例破裂）接受了急诊手术，78例患者（仅23例无症状）接受了择期手术。40%的患者术前通过CT扫描确诊IAAA。发现23例患者（14例双侧，9例单侧）的37条输尿管受压，9例患者（12条输尿管）术前进行了输尿管支架置入术。手术方式为正中剖腹术（88例患者）或腹膜后入路（21例患者）。1例患者通过股动脉途径采用血管内Min-Tec支架型主动脉移植物进行治疗。44例患者需要进行肾上极阻断。对23条输尿管进行了输尿管松解术。术中成功处理了3例术中医源性损伤。
9例患者（8%）发生致命并发症，5例在急诊手术后，4例在择期手术后，均与技术问题有关。22例患者发生非致命并发症，10例患者（2例需长期透析）肾功能不全最为严重。平均随访时间为4.5年（范围0.5至15年）。5年时的晚期生存率为68%，10年后为42%。7例患者出现晚期移植物相关并发症，1例致命。在14例存活且21条输尿管已松解的患者中，1例需要进行肾切除术，1例需要进行双侧鲍里成形术。在8例存活且11条输尿管已置入支架的患者中，1例患者因输尿管狭窄需要进行小肠间置术。术后3至6个月，经CT评估后，所有输尿管支架均被取出。
