腘动脉瘤的外科治疗

Surgical treatment of popliteal artery aneurysms

目的探讨腘动脉瘤的外科治疗方法。方法回顾性分析2004—2010年收治的腘动脉瘤9例临床资料。结果全组9例(患肢11条)中,男6例,女3例;平均年龄为53.8岁。双侧腘动脉瘤2例,左侧4例,右侧3例;合并双侧髂动脉瘤1例。无症状1例,搏动性肿块2例,肿块伴局部疼痛3例,慢性下肢缺血1例,急性下肢缺血2例。外科手术7例,7个腘动脉瘤;非手术治疗2例(其中1例行双髂动脉瘤手术)。手术方法均采用腘动脉瘤切除+人工血管或大隐静脉重建术。随访0.5个月至6年,术后搏动性肿块消失,疼痛消失,足背动脉搏动良好,患肢症状均有明显改善。结论动脉粥样硬化是最主要的病因。有症状及直径大于2 cm的腘动脉瘤应早期手术治疗,特别是瘤腔内有附壁血栓更有手术指针。动脉瘤切除后行人工血管和自体静脉的置换近远期通畅率无明显差别。

Objective To investigate the surgical treatment for patients with popliteal artery aneurysm（PAA）.Methods The clinical data of 9 patients with popliteal artery aneurysm admitted to our department from 2004 to 2010 were retrospectively analyzed.Results Nine patients（6 males and 3 females） with average age was 53.8 years.Of the patients,2 cases had bilateral PAAs（one of which coexisted with bilateral iliac artery aneurysms）,4 cases had left and 3 cases had right PAAs.One patient had asymptomatic PAA and 8 cases had symptomatic PAAs that presented with pulsating mass in 2 cases,a mass with local pain in 3 cases,and chronic and acute lower extremity ischemia in one and two cases,respectively.Seven patients underwent surgical repair and the other 2 patients received non-surgical treatment（one of which underwent surgery of bilateral iliac artery aneurysms initially）.Aneurysm resection and eFTFE graft or autologous saphenous vein interposition was performed in the operated patients.Follow-up of 0.5 month to 6 years was available in 8 patients.Symptoms of the affected limbs were obviously ameliorated,and pulsating masses and limb pain were disappearred after operation.The dorsalis pedis artery could be palpated in all cases.Conclusions Atherosclerosis is the main cause of PAA.Early elective surgical repair is suggested for symptomatic PAA or asymptomatic PAA with diameter larger than 2 cm,and is especially indicated for thrombosed PAAs.There is no significant difference between eFTFE and autologous saphenous vein graft in short-term and long-term patency.