Shih C C, Lai S T, Chang Y
Department of Surgery, National Yang-Ming University, Taipei, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 1998 Apr;61(4):210-5.
What is the best surgical timing for symptomatic AAA? Surely, the answer depends on accurate and prompt diagnosis of 'rupture or not'. Abdominal CT is one of the reliable and familiar diagnostic tools. We will present our own CT classification method for symptomatic AAA which is used as the guideline for 'emergency or not'.
From January 1989 to January 1995, 52 patients with symptomatic AAA received diagnostic CT scan for quick disease differentiation and determination of surgical emergency. The findings were classified into four categories. Category I included 26 patients with intact aorta; Category II included four patients with contained retroperitoneal abdominal aortic leakage; Category III included 14 patients with contained massive retroperitoneal hematoma; and Category IV included eight patients with retroperitoneal or intraperitoneal active bleeding.
Compared with the standard diagnosis of rupture via laparotomy, CT is an excellent tool, showing 88% sensitivity and 88% specificity. This is better than sonography, which has a high false-positive rate of 33% and low specificity of 62%. Hospital mortality was distinctive with 4.3% in Category I, none in Category II, 25% in Category III and 87.5% in Category IV.
In our experience, CT scan is a better diagnostic tool than sonography for symptomatic AAA. Even the delay imposed by obtaining a preoperative CT scan in patients with possible ruptured aneurysm does not adversely affect the patient's outcome. The information obtained significantly aids not only preoperative but also intraoperative management.
有症状的腹主动脉瘤（AAA）的最佳手术时机是什么？当然，答案取决于对“是否破裂”的准确和及时诊断。腹部CT是可靠且常用的诊断工具之一。我们将介绍我们自己用于有症状AAA的CT分类方法，该方法用作“是否紧急”的指导原则。
从1989年1月至1995年1月，52例有症状的AAA患者接受了诊断性CT扫描，以快速区分疾病并确定手术紧迫性。检查结果分为四类。I类包括26例主动脉完整的患者；II类包括4例腹膜后腹主动脉局限性渗漏的患者；III类包括14例腹膜后大量血肿局限的患者；IV类包括8例腹膜后或腹腔内活动性出血的患者。
与通过剖腹手术进行的破裂标准诊断相比，CT是一种出色的工具，敏感性为88%，特异性为88%。这优于超声检查，超声检查假阳性率高达33%，特异性低至62%。医院死亡率有显著差异，I类为4.3%，II类无死亡，III类为25%，IV类为87.5%。
根据我们的经验，对于有症状的AAA，CT扫描是比超声检查更好的诊断工具。即使对于可能破裂的动脉瘤患者，术前进行CT扫描所带来的延迟也不会对患者的预后产生不利影响。所获得的信息不仅对术前管理有很大帮助，对术中管理也有很大帮助。
