假性动脉瘤外科治疗19例报告

Surgical Treatment of Pseudoaneurysm: Report of 19 Cases

观察用手术方法重建自流通道治疗假性动脉瘤的疗效。方法:术前动脉造影和超声检查对诊断提供可靠依据;对动脉壁裂口较小行单纯动脉壁修补术;纵行伤口,少于管壁周径二分之一行补片移植修复术;严重挫裂伤和撕裂伤行人造血管或自体大隐静脉间置移植术;分支动脉、终末支动脉假性动脉瘤行单纯缝扎和结扎术。结果:本组2例失访,其余17例已分别随访3～94个月,平均42.5个月。疗效良好者16例,都已恢复正常的活动和工作能力;仅1例腘动脉假性动脉瘤压迫引起神经麻痹,于术后12个月仍未恢复。所有患者均未见远端组织动脉血供不足现象,无局部复发。结论:假性动脉瘤一旦明确诊断,应及时手术治疗。术中有效地控制血流和手术方式的选择是手术成功的重要保证。

Aims:To evaluate the therapeutic effect of surgical reconstructions of blood vessels in pseudoaneurysm. Methods: From Jan. 1988 to Dec. 1996, 19 patients with pseudoaneurysm were treated surgically. The surgical technique depends on the location of the aneurysm. Small, single, peripheral false aneurysm of the radial and tibial arteries or branch of the arterial trunk could be safely ligated, if repairing is with difficulty. A small opening leading to a saccular aneurysm may be close by lateral arteriorrhaphy. When there is circumferential loss of less than half arterial wall substance, autologous vein patch are used. While there is a severe straining or tearing of the arterial wall, in large aneurysm, interposition of a PTFE or autologus vein prothesis has to be used. Results: The results were excellent in 17 patients with a follow-up period of 3~94 months (mean 42.5 months). All the cases have good blood perfusion at the end extremities. Conclusions: Once the diagnosis of pseudoaneurysm is made, emergency surgery is necessary to prevent rupture. Angiography and ultrasonic examination is crucial for the diagnosis.