腹主动脉瘤治疗研究的最新进展与展望

Recent Advances and Future Perspectives in the Treatment Research of Abdominal Aortic Aneurysms

摘要: 腹主动脉瘤(Abdominal Aortic Aneurysm, AAA)作为一种常见的血管疾病，其治疗策略近年来取得了显著进展。本文系统回顾了AAA的治疗研究现状与发展趋势。文章首先介绍了AAA的基本特征、流行病学背景及其主要的病理生理机制，强调了高龄、男性、吸烟和高血压等风险因素在疾病发生中的重要作用，并指出早期筛查和诊断对改善患者预后的重要意义。在治疗方面，传统开放修复手术(Open Repair, OR)和内科保守治疗仍然是重要的治疗手段，尤其适用于不适合微创手术的患者群体。内科治疗通过他汀类药物、抗血小板药物和降压药等综合管理措施，能够有效控制心血管风险，提高患者生存率。近年来，血管腔内修复术(Endovascular Aneurysm Sealing, EVAR)作为一种微创技术，因其手术时间短、术后恢复快等优点，在临床中得到广泛应用，但也存在二次干预的可能。此外，曾一度备受关注的血管内动脉瘤封堵术(Endovascular Aneurysm Sealing EVAS)因远期并发症较多，已逐渐退出临床应用。药物治疗研究显示，血管紧张素转化酶(Angiotensin-Converting Enzyme, ACE)抑制剂、二甲双胍及某些抗炎药物在延缓动脉瘤进展和降低破裂风险方面展现出潜在价值。个体化治疗和精准医疗策略基于基因型和生物标志物分析，为高风险患者提供了更具针对性的干预方案。人工智能技术在AAA影像识别、风险评估和手术规划中表现出良好的应用前景，有望进一步提升早期诊断和个性化治疗水平。然而，新技术的应用也带来了伦理、法律和经济方面的挑战，需要在技术创新与公平可及之间找到平衡。总体来看，AAA治疗正朝着微创化、个体化和智能化的方向发展，未来仍需开展更多高质量的临床研究，以验证各种新策略的有效性与安全性。

Abstract: Abdominal Aortic Aneurysm (AAA) is a common vascular disease, and its treatment strategies have made significant progress in recent years. This article systematically reviews the current status and development trends of AAA treatment research. Firstly, it introduces the basic characteristics, epidemiological background, and main pathophysiological mechanisms of AAA, emphasizing the significant roles of risk factors such as advanced age, male gender, smoking, and hypertension in the occurrence of the disease, and highlighting the importance of early screening and diagnosis for improving patient prognosis. In terms of treatment, traditional open repair (OR) surgery and medical conservative treatment remain important therapeutic methods, especially for patients who are not suitable for minimally invasive surgery. Medical treatment, through comprehensive management measures such as statins, antiplatelet drugs, and antihypertensive drugs, can effectively control cardiovascular risks and improve patient survival rates. In recent years, endovascular aneurysm sealing (EVAR) as a minimally invasive technique has been widely used in clinical practice due to its advantages such as short operation time and fast postoperative recovery. However, there is a possibility of secondary intervention. Additionally, the endovascular aneurysm sealing (EVAS), which was once highly concerned, has gradually withdrawn from clinical application due to its numerous long-term complications. Drug treatment research shows that angiotensin-converting enzyme (ACE) inhibitors, metformin, and certain anti-inflammatory drugs show potential value in delaying aneurysm progression and reducing the risk of rupture. Individualized treatment and precision medical strategies based on genotyping and biomarker analysis provide more targeted intervention plans for high-risk patients. Artificial intelligence technology shows good application prospects in AAA imaging recognition, risk assessment, and surgical planning, and is expected to further improve early diagnosis and personalized treatment levels. However, the application of new technologies also brings ethical, legal, and economic challenges, and a balance needs to be found between technological innovation and equitable accessibility. Overall, AAA treatment is developing towards minimally invasive, individualized, and intelligent directions. In the future, more high-quality clinical studies are needed to verify the effectiveness and safety of various new strategies.