周围动脉瘤的外科和介入治疗

Surgical Treatment and Interventional Therapy of Peripheral Aneurysm

目的：总结周围动脉瘤的诊断、外科和介入治疗体会。方法：20例周围动脉瘤患者，2例行腔内修复治疗，18例行外科手术治疗，后者中损伤动脉管壁裂口直接修补3例，动脉瘤切除自体大隐静脉移植11例、人造血管移植3例，股深动脉假性动脉瘤切除及动静脉瘘结扎1例；1例合并髂动脉瘤和腹主动脉瘤者同时行髂动脉瘤和腹主动脉瘤切除人工血管移植术，1例合并下肢缺血患者行胭动脉切开取栓，1例并发小腿骨筋膜室综合征者行切开减压术。结果i2例腔内修复治疗者一期治愈出院。18例手术患者，16例一期治愈出院；1例出现远端肢体缺血行动脉切开取栓后痊愈出院，另1例小腿骨筋膜切开减压者行二期植皮，并遗留部分腓总神经缺血症状。随访17例，随访时间4个月～5年（平均15个月），均未发现肢体远端明显缺血症状和动脉瘤复发。结论：周围动脉瘤选择恰当的治疗方法均可获得良好的疗效，腔内修复治疗周围动脉瘤是安全可行的。

Objective： To summarize the experience about the diagnosis, surgical treatment and interventional therapy of peripheral aneurysm. Methods：Twenty patients with peripheral aneurysm consisted of two cases received the endovascular covered stent graft and eighteen cases adopted surgical interventions ,the later ineluded three cases of direct repair for the cracks of injuried arterial wall, eleven of aneurysmectomy combined autogeneic great saphenous vein grafting, three of aneurysmectomy combined antificial blood vessel grafting, and one of aseetron of pescudoaneurysm in arteria profunda femoris and ligation of arteriovenous fistula. Among eighteen cases undergone surgical procedure, one patient accompanied with the abdominal aortic aneurysm and iliac aortic aneurysm was treated with aneurysmectomy and artificial vascular grafting;another one accompanied with lower limb ischemia was treated by arteriotomy of popliteal artery and embolectomy. The third patient accompanied with osteofaseial compartment syndrome in his lower leg received open decompression. Results ：Two patients undergone interventional therapy and sixteen of eighteen patients adopted surgical treatment gained primary healing, other two patients included one was cured by second surgical procedures due to the less perfusion at the distal part of extremity, and another one with the decompression of osteofascial compartment syndrome of the lower leg was performed skingrafting and remained partial ischemia symptom of common peroneal nerve. Seventeen patients were followed up for 4 months to 5 years（ average 15 months ）, no recurrence of aneurysm and ischemia symptom were noted in these patients. Conclusion：The eligible therapy for peripheral aneurysm would leads to good clinical results, and the endovascular stent - graft repair is an effective, feasible and less invasive technique.