多发性大动脉炎8例临床分析

Assesment of diagnosis and treatment of Obliterative brachiocephalic arteritis (Takayasu arteritis, TA)

目的:探讨头臂型大动脉炎的诊断和治疗方法.方法:回顾性分析8例多发性大动脉炎的临床资料,在8例头臂型大动脉炎患者中重症头臂型5例,其中双侧颈总动脉、锁骨下动脉闭塞3例,行升主动脉-双侧颈总动脉-双侧锁骨下动脉与人造血管搭桥.一侧颈总动脉、双侧锁骨下动脉闭塞1例,行升主动脉 -左侧颈总动脉-双侧锁骨下动脉与人工血管搭桥.左侧颈总动脉及左侧锁骨下动脉闭塞1例,行锁骨动脉-锁骨下动脉-左颈总动脉与人造血管搭桥.其余3例单侧锁骨下动脉闭塞行锁骨下动脉-锁骨动脉与人造血管旁路术.结果:8例大动脉炎患者随防5个月～9年,1例手术后第3年复发,行第二次手术,7例患者的脑缺血及上肢缺血症状消失,能进行正常生活和工作.结论:大动脉炎活动期最好用皮质激素,扩张血管,降低血液粘滞度抗血小板聚集等药物保守治疗,病情稳定后,根据病变的血管情况来选择血管重建术和术后继续抗凝治疗是治疗大动脉炎的有效方法.

Objective: To evaluate the diagnosis and treatment of Obliterative brachiocephalic arteritis (Takayasu arteritis, TA). Methods: Five cases with middle to severe TA of total 8 patient received grafting from ascending aorta-bilateral common carotid artery-bilateral subclavian artery. 1 with artifitial vascular grafting of subclavian artery-subclavian artery-single common carotid artery and 1 with bypassing of ascending aorta-single common carotid artery-bilateral subclavian artery. 3 patients suffering from occlusion of single subclavian artery receiving artifitial vascular bypassing. Results: Eight cases were followed-up for 5 month to 9 years, one of them taking second operation 3 year after operation, and all patient's symptoms disappeared and living and working activity were normal. Conclusion: The best treatment during progression of obliterative brachiocephalic arteritis was medication. Revascularization after stabilizing was the effective way of treatment, the surgeon should choose the method of revascularization according to the state of occlusion.