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腹主动脉瘤的临床特征与诊断

Authors
Jeffrey Jim, MD
Robert W Thompson, MD
Section Editors
Joseph L Mills, Sr, MD
John F Eidt, MD
Emile R Mohler III, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
邵江, 主治医师

引言

腹主动脉瘤(abdominal aortic aneurysm, AAA)是腹主动脉的局部异常扩张，该病相对常见且可能导致严重并发症和死亡。大多数AAA患者是无症状的，但通过体格检查发现搏动性包块、由于其他腹部影像检查或通过AAA超声筛查项目才前来就诊[1]。当症状确实出现时，患者常表现为腹痛、背痛或腰痛，但也可发生血栓栓塞导致肢体缺血症状。出现症状的动脉瘤其破裂风险增加，并伴有高死亡率。

AAA诊断通常需要影像学证实动脉瘤的存在，最常用腹部超声检查来证实。然而，对于有症状的患者，腹部计算机断层扫描(computed tomography, CT)可提供额外的信息，从而可确定动脉瘤是否已破裂、在迅速扩大以及(对于那些没有破裂征象的患者，可确定)症状是否可能与动脉瘤相关或是由其他腹部病变所致。

AAA的临床特征和诊断将总结在此。非破裂或破裂性AAA的处理将在别处讨论。(参见“无症状腹主动脉瘤的治疗”，关于‘引言’一节和“症状性(未破裂)和破裂性腹主动脉瘤的治疗”，关于‘引言’一节)

动脉瘤的定义和解剖学

动脉瘤定义为血管的节段性、全层扩张，比正常直径大50%[2,3]。虽然“正常”直径随年龄、性别和体型有所不同，但人类肾下主动脉的平均直径约为2.0cm；正常上限通常小于3.0cm[4]。因此，对于大多数患者，最大直径大于或等于3.0cm的肾下主动脉即是动脉瘤[2,4,5]。肾上主动脉的正常直径倾向于比肾下主动脉大0.5cm左右。

主动脉随年龄增长而扩张，年长患者的正常主动脉直径往往更大。在一项以人群为基础的研究中，应用磁共振成像(magnetic resonance imaging, MRI)获得70岁患者不同水平段的主动脉直径，平均直径如下[6]：

                         

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Literature review current through: 2017-06 . | This topic last updated: 2016-06-28.
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