17例腘动脉瘤的手术治疗经验

Surgical treatment of popliteal artery aneurysms: 17 cases experience

目的总结腘动脉瘤的手术治疗经验及效果。方法回顾性分析1999年1月至2011年12月收治的腘动脉瘤患者的病历资料。结果共纳入17例患者、21条肢体,其中男性14例、女性3例,平均年龄(45.13±11.24)岁,其中4例患者为双侧病变。主要临床表现有腘窝搏动性包块15例(71.4%)、腘窝疼痛5例(23.8%)、间跛5例(23.8%)、急性下肢缺血3例(14.3%)。所有患者均行手术治疗,手术方式包括动脉瘤切除、自体大隐静脉原位移植10例,动脉瘤切除、人工血管原位移植3例,动脉瘤结扎、人工血管旁路移植4例,其中3例急性下肢缺血患者术中均行取栓术。1例患者在人工血管原位移植术后6 h出现移植物内血栓形成。术后平均随访(7.36±3.58)年,13例(76.5%)患者症状缓解,2例患者人工血管移植术后1年出现吻合口狭窄,1例患者术后8个月因膝下动脉闭塞而行大腿下1/3截肢术,1例患者失访。1期通畅率81%,保肢率95%。结论腘动脉瘤均应积极手术治疗,移植物首选自体大隐静脉,术后应给予足量、合理的抗凝或抗血小板治疗。

Objective To summarize the experience and effect of the surgical treatment in treating of popliteal artery aneurysm(PAA). Methods The clinical data of 17 patients with PAA from January 1999 to December 2011 was analyzed retrospectively. Results 17 cases were brought into the research, with 21 limbs involved. The mean age was(45.13±11.24) years. 14 cases were male and 3 cases were female, 4 cases with bilateral lesions. The clinical manifestations were pulsatile mass(15 cases, 71.4%), popliteal fossa pain(5 cases, 23.8%), intermittent claudication(5 cases, 23.8%), acute lower limb ischemia(3 cases, 14.3%). All of the patients had underwent successful surgical treatment. The surgical procedures including aneurysm excision and auto genous great saphenous vein graft in situ(10 cases), aneurysm excision and artificial vascular graft in situ(3 cases), aneurysmligation and artificial vascular bypass graft(4 cases). 3 cases with acute lower limb ischemia underwent embolectomy. 1 case developed thrombosis in artificial vascular 6 hours after the operation. The mean follow-up was(7.36±3.58) years. The symptoms had been alleviated in 13 cases. 2 cases with artificial vascular grafts were found anastomotic stenosis 1 year after surgery. 1 patient with arteriosclerosis obliterans had underwent amputation from the lower third of the thigh 8 months after surgery. 1 case was lost to follow-up. The primary patency rate was 81%, limb salvage rate was 95%. Conclusions Surgical treatment is recommended regardless of the size of the PAA. Autogenous saphenous vein is recommended as the preferred graft. Adequate, reasonable anticoagulant or antiplatelet drugs should be administrated after the surgery.