假性股动脉瘤的外科治疗

Surgical Treatment For Femoral Pseudoaneurysm

目的总结假性股动脉瘤的外科治疗方法。方法回顾性分析我科2002年5月～2006年6月收治的23例假性股动脉瘤患者，其中注射毒品引起14例，外伤性6例，医源性3例。1例拒绝手术，22例假性动脉瘤被切除，其中8例行股动脉修补，10例行人工血管搭桥，3例行股动脉结扎，1例下肢缺血坏死，股动脉缺损无法修补或搭桥，行高位截肢术。结果拒绝手术的1例出院1周后死亡，其余均痊愈出院。3例失访，19例获随访，平均1．7（1～3）年，3例股动脉结扎者患肢皮温正常，1例人工血管旁路手术者术后3年复查DSA示人工血管闭塞但侧支循环良好，不影响患肢功能，其余患者效果良好。结论假性股动脉瘤一经发现须早期手术治疗，破裂、感染会严重影响治疗效果甚至危及生命。假性动脉瘤切除、自体血管重建或人工血管搭桥是首选治疗方法。对病程较长、瘤体较大、压迫症状明显者可行高位股动脉结扎。

Objective To summarize the experience of the surgical treatment of femoral pseudoaneurysm. Methods 23 cases of femoral pseudoaneurysm admitted from May 2002 to June 2006 were retrospectively analyzed. The etiology included that 14 cases were drug injecting, 6 cases were trauma and 3 cases were iatrogenesis. The pseudoaneurysms were resected in 22 cases. 1 case refused operation. The arteries were reconstructed by auto vessels in 8 cases and by grafts in 10 cases. The femoral artery was ligated in 3 cases for severe infection of the leg. One patient received left leg high-level amputation for ischemia of left lower limb. The patient who refused surgical therapy died after discharge. The other patients discharged well after recovery. 19 patients received follow-up with 1 to 3 years and results showed very well. Conclusions Surgical treatment should be proceeded as early as possible for femoral pseudoaneurysm. The rupture and infection of pesudoaneurysms would affect the therapeutic efficacy. Resecting pseudoaneurysm, reconstructing femoral artery by auto vessels or grafts is the optimal procedure. High-level ligation of femoral artery will not cause limb necrosis for the case with long-term history and giant aneurysm.