毒品注射致腹股沟区血管损伤的诊断及治疗

Diagnosis and management of vascular injury in the groin area secondary to intravenous drug abuse

腹股沟区毒品注射引起股动脉假性动脉瘤病人逐年增加,在诊治上有其特殊性。典型的临床表现为化脓、出血及搏动的腹股沟包块,晚期表现为动脉瘤破裂大出血及低血容量休克。彩色多普勒超声(CDU)、CT动脉造影(CTA)、MR动脉造影(MRA)可辅助诊断。治疗方法以手术为主。假性动脉瘤切除、腹股沟区彻底清创后,可根据情况选择单纯股动脉结扎术;同期或分期行血管重建术:股动脉修补术、股动脉端端吻合术、股动脉自体血管或人工血管旁路术。有应用介入方法成功治疗的报道。血管重建与否是手术者需考虑的问题,但不影响总的手术并发症发生率。

Cases with groin pseudoaneurysms caused by drug abuse are increasing year by year. The diagnosis and management are special. Typical clinical manifestations include purulence,hemorrhage and a tender mass in groin area. Some cases present acutely with aneurysm bleeding and hypovolemic shock as late symptoms. Color Doppler ultrasound （CDU）,computer tomography angiography （CTA）, magnetic resonance angiography（MRA ）are helpful to confirm the diagnosis. The management options include excision of pseudoaneurysms and debridement either without arterial reconstruction （femoral artery ligation only）;or with selective arterial revascularization （femoral artery repair,femoral artery end to end anastomosis,or graft or prosthesis bypass）. Successful radiological intervention therapy has been reported to treat femoral artery pseudoaneurysm by drug abuse. The option of arterial reconstruction is a challenge to the operator. In the long term,arterial reconstruction wouldn’t influence the overall surgical complication incidence.