人工血管移植治疗孤立性髂动脉瘤的手术探讨

Investigation of Surgical Treatment of the Isolated Iliac Aneurysm with Vascular Prosthesis

目的探讨孤立性髂动脉瘤的手术治疗方法,包括复杂病理情况下动脉瘤切除、人工血管移植以及吻合口处理和缝合问题。方法回顾性总结1997年1月至2007年6月间收治的33例孤立性髂动脉瘤的临床资料,其中单侧髂动脉瘤29例,双侧4例。均在全身麻醉下行动脉瘤切除、人工血管移植血管重建术。结果4例双侧病变中,行主动脉-双侧股动脉人工血管移植1例,主动脉-双侧髂总动脉人工血管移植3例;29例单侧病变中,主动脉-髂总动脉人工血管移植1例,髂动脉-股动脉人工血管移植3例,髂总动脉-髂外动脉人工血管移植21例,髂总-髂总动脉转流4例。33例平均随访5（0.5-10）年。2例分别于术后3年和6年死于急性脑梗塞和心肌梗塞,1例术后2年死于交通事故,余健康存活,无复发,无吻合口狭窄或下肢缺血表现。结论动脉瘤切除人工血管移植是治疗孤立性髂动脉瘤的良好措施,仍然是目前医疗条件下有效治疗本病的主要手术方式。

Objective To investigate the operative method for isolated iliac aneurysm （IIA）, especially the method of IIA ablation, vascular prosthesis transplantation, and the vascular stoma selection and suturing under some sophisticated pathologic conditions. Methods 33 patients with IIA admitted from Januarary 1997 to June 2007 were analyzed retrospectively, including 29 of unilateral IIA and 4 of bilateral IIA. All cases were underwent aneurysm resection and vascular reconstruction with vascular prosthesis under general anaesthesia. Resuits The procedures of 4 bilateral IIA cases were aorta-bilateral femoral artery artificial vessels bypass in 1 case and aorta-bilateral common iliac artery artificial vessels bypass in 3. Among the 29 cases with unilateral IIA, the procedures were as follows： aorta-common iliac artery artificial vessels bypass in I, iliac -femoral artery artificial vessels bypass in 3, common iliac-external iliac artery artificial vessels bypass in 21, and common iliac-common iliac artery artificial vessels bypass in 4. All cases were followed up for 0.5 to 10 years （average 5 years）. 2 cases died of acute cerebral and myocardial infarction respectively at 3 and 6 years after operation, and 1 died of traffic accident at 2 years postoperatively. The other patients were survived without recurrence, stoma stenostomia or lower limb ischemia. Conclusion It is a good, chief and effective procedure of aneurysm ablation and vascular prosthesis transplantation to treat the IIA in the current medical conditions.