外伤性假性动脉瘤术后再出血原因与处理

Analysis of reasons and management in postoperative rehemorrhage of traumatic false aneurysms.

本文分析10例外伤性假性动脉瘤术后再出血原因:①炎症引起动脉修复处腐蚀,裂开出血;②邻近部位动静脉瘘出血;③术中对假性动脉瘤供血动脉处理不当;④误诊、误治。术后再出血,应立即控制出血,施行急诊手术。动脉处理方法,应根据损伤部位,动脉壁炎性范围来决定。采用气囊导管暂时阻断动脉腔内血流,与直接手术或血管内栓塞治疗相结合方法,适用于邻近躯干部位的病变。由炎症诱发瘤壁破裂大出血,应用肌瓣包裹动脉修复处,有助于预防术后再出血。

The reasons in postoperative rehemorrhage of traumatic false aneurysms were analysed:(1) The erosion and dehiscent bleeding of reparative artery were caused by the inflammation. (2) Arteriovenous fistula near by the position led bleeding. (3) Supplied artery of false aneurysm not were handled properly. (4) Misdiagnosis and wrong treatment. Once rebleeding occured, emergency surgery was necessary to stop bleeding. The repair of the artery depended on the position and the range of inflmmation. In the false a-neurysms closed to trunk,we suggest repair of the artery and intr.avascular embolic treatment after temporary occlusion of blood circulation by balloon catheter. The accurate diagnosis of preoperation,careful manipulate during operation,and repaired artery of encapsulation with muscle flap may prevent post-operative rebleeding.