手术治疗先天性肢体动静脉瘘的术式选择

Surgical Treatment of Congenital Arteriovenous Fistula(e) of the Extremities: A Report of 76 Cases

目的：评估不同术式对先天性肢体动静脉瘘的疗效。方法：对７６例先天性肢体支动静脉瘘病人分别采用下列４种手术方法：①瘘管结扎和病变切除；②瘘管结扎、病变切除和血流重建；③分期分段瘘管结扎；④介入栓塞术。结果：除８例失访外，其余６８例平均随访６．８年。疗效良好者３４例，占４４．７％；好转２１例，占２７．６％。总有效率达７２．３％。结论：术前选择性动脉造影可对诊断和手术方案制订提供可靠依据，瘘管结扎和病变切除是手术成功的关键，非主干营养动脉病变可考虑介入栓塞治疗。

Objective: To evaluate the effects of surgical treatment on congenital arteriovenous fistula(e) in the extremities. Methods: From June 1982 to June 2000, 76 patients with congenital arteriovenous fis-tula(e) of the extremities were treated surgically. Operative procedures included ligation of the arterio-venous fistula(e), excision of the arteriovenous malformation, vascular reconstruction by autogenous vein graft and transcatheter embolization. Results: Excellent and good results of operation were obtained in 34 and 24 cases respectively, and the total effective rate was 72.3 percent with a mean follow-up period of 6.8 years. Conclusions: Angiography is crucial for diagnosis. The results of surgical treatment of congenital arteriovenous fistula(e) are gratifying. The best results are to be expected after excision of well-localized lesions without bone and nerve involvement.