11例腘动脉瘤的诊断与治疗

Diagnosis and Treatment of Popliteal Aneurysm:Report of 11 Cases

目的对我院诊治的腘动脉瘤病例进行总结。方法查阅我院1975～2004年11例腘动脉瘤患者病历，对其资料进行分析。结果本组患者11例、患肢11条，常见的临床表现依次为腘窝搏动性肿块、跛行、伸膝困难、肿块疼痛等，动脉瘤破裂3例（27．3％）。接受的特殊检查有动脉造影、彩色多普勒。10例行手术治疗，手术方式包括：动脉瘤内缝合修补术4例；动脉瘤切除、血管移植术6例。病理结果：假性动脉瘤3例、梅毒性动脉瘤3例、动脉粥样硬化性动脉瘤4例。1例动脉瘤内缝合修补术后出现患侧小腿干性坏疽而行患侧大腿下1／3截肢术。1例全身情况太差而未接受手术者死于心功能衰竭、晚期梅毒。术后随访1．5～30年，另外3例接受动脉瘤内缝合修补术患者中1例有间歇性跛行；1例患肢足背动脉能扪及搏动，无肢体缺血表现；1例失访。6例接受动脉瘤切除、血管移植术患者中，1例失访（Dacron人造血管移植）；1例有间歇性跛行；4例患肢足背动脉能扪及搏动，无肢体缺血表现。结论推广彩色多普勒在人群筛查中的应用可能有助于腘动脉瘤的检出。有症状的腘动脉瘤及直径大于3cm的无症状腘动脉瘤应接受手术，直径小于或等于3cm的无症状腘动脉瘤可定期随访观察。

Objective To present and summarize the data concerning the diagnosis and treatment of popliteal aneurysm in our hospital. Methods The data of popliteal aneurysm in our hospital from 1975 to 2004 were reviewed and analyzed. Eleven patients with 11 diseased limbs were treated, including 8 males and 3 females, age from 21 years to 64 years [（48. 54 ±13. 66） years]. The combined diseases include syphilis, rheumatic heart disease and chronic obstructire pulmonary disease etc. Ten patients received operations, including endoaneurysmorrhaphy （n = 4） and graft bypass after aneurysmal resection （n = 6）, through posterior approach （n = 7） or medial approach （n= 3）. One patient, combined with advanced syphilis and heart failure, received conservative treatment because of his poor general condition. Results The common clinical manifestations included popliteal pulsating mass, claudica tion, difficulty in extension of the knee, pain etc. Acute ischemia occurred in 3 limbs. The diameter of popliteal aneurysms varied from 4-13 cm [（6. 73±2.69） cm]. There were 3 （27.3%） cases of ruptured aneurysms whose diameters were 7 era, 7 cm and 11 cm respectively. Special examinations included arteriography and Doppler sonography. Pathological results of these patients were pseudoaneurysm （n= 3）, syphilitic aneurysm （n= 3） and atherosclerotic aneurysm （n= 4）. Two patients were not followed up, and postoperative follow up of the other 8 patients ranged from 18 months to 30 years. In the group of endoaneurysmorrhaphy, postoperative gangrene of the affected limb occurred in one patient, and above-knee amputation was performed. One patient suffered from intermittent claudication in the group of endoaneurysmorrhaphy and of graft bypass respectively. No manifestations of limb ischemia were found in the other 5 patients during the time of follow up. Conclusion General utilization of Doppler sonography in screening high risk patients might be helpful to detect popliteal aneurysm. For symptomatic popliteal aneurysm or asymptomatic popliteal aneurysm with diameter larger than 3 era, operation is indicated. Asymptomatic popliteal aneurysms no more than 3 cm in diameter could be monitored with care.