兔颈总动脉创伤性假性动脉瘤的病理研究

Development and treatment of traumatic pseudoaneurysm of common carotid artery

目的 观察兔颈总动脉创伤性假性动脉瘤 (TPA)模型的病理改变 ,探讨人颈内动脉TPA血管内栓塞治疗的时机与方法。方法 运用显微外科操作 ,制作 2 0只兔右侧颈总动脉TPA模型 ,并行彩色超声多普勒随访及病理检查。结果 术后 6～ 12d 2 0只兔均于手术部位出现明显的搏动性包块并经彩色多普勒超声检查证实为假性动脉瘤形成。术后 2周内瘤腔直径均不超 5mm ,瘤壁由部分机化的血栓构成 ,薄且不均匀。术后 3～ 4周瘤径增大至 10 5～ 18.0mm ,病理大体检查见瘤体与周围组织有一潜在间隙 ,瘤壁厚约 2～ 3mm ,由致密的纤维结缔组织构成。术后第 7周瘤径增大至 3 5 5～ 5 2 .0mm ,瘤壁厚薄不均 ,瘤顶处瘤壁菲薄。结论 对于颈内动脉TPA ,在其形成期的早期及瘤体增大期 ,闭塞载瘤动脉最为安全、有效 ;在瘤体稳定期 。

Objective To study the development of traumatic pseudoaneurysm (TPA) of internal carotid artery (ICA) in rabbits and discuss the endovascular therapy of TPA of internal carotid artery in human. Methods Twenty TPAs were surgically made in the rabbit right common carotid arteries. The TPAs were examined by color Doppler ultrasonography (CDU) and pathology. Results Six to twelve days after operation, pulstile masses occurred in all the rabbit right common carotid arteries, which were proved to be TPAs by CDU. Two weeks after operation, the size of TPAs was less than 5 mm and the wall of TPAs was compossed of a layer of thin and inuniform thrombus. Three to four weeks after operation, the diametre of TPAs were increased to 10.5～18.0 mm. Gross pathologic examination showed that there was a potential lacuna between TPA and peripheral tissue with a wall of 2～3 mm in thickness, which was composed of a layer of compact fibro-connective tissue. Six weeks after operation, the diametre of TPAs was 35.5～52.0 mm and the wall became uneven, the tip of which was extremely thin. Conclusion Parent artery embolization is the safest and most effective way of treating TPA of ICA in its early stage of formation and development. TPA in stage can be cured by occlusion of the lumen with microcoil(MC).