主动脉疾患误诊为下肢动脉血栓栓塞九例分析  

Aorta diseases misdiagnosed as simple inferior limb thrombo-embolism in 9 cases

作　　者：张赞松[1] 段志泉[1] 辛世杰[1] 王传疆[1] 杨德华[1] 

机构地区：[1]中国医科大学附属一院血管与甲状腺外科,沈阳110001

出　　处：《中华普通外科杂志》2009年第12期999-1001,共3页Chinese Journal of General Surgery

摘　　要：目的分析主动脉疾患误诊为下肢动脉血栓栓塞的原因，总结经验教训。方法回顾性分析9例主动脉疾患误诊病例的临床表现、误诊误治情况及确诊方法。结果9例均初诊为下肢动脉血栓栓塞。其中3例急诊行Fogarty导管取栓术，术后通过三维CT血管造影（3-dimensional CT angiography，3DCTA）检查明确诊断；另6例于术前行3DCTA而确诊为主动脉疾患。本组中5例为主动脉夹层累及髂股动脉，其中1例主动脉夹层患者放弃治疗后1d死亡；另1例主动脉夹层患者拒绝治疗，离院后失访；3例成功施行腔内修复术。1例为腹主动脉瘤腔内附壁血栓脱落，施行动脉瘤切除术。其余3例为Leriche综合征合并急性主动脉末端血栓形成，施行主髂动脉旁路术。本组无围手术期死亡，治疗后患肢缺血均改善。结论主动脉疾患也可引起急性下肢缺血，易被误诊为肢体动脉血栓栓塞。Objective To analyze the causes of misdiagnosis of aorta diseases for simple inferior limb artery thrombo-embolism, and summarize the clinical experience. Methods Retrospective analysis was made on clinical data of 9 cases misdiagnosed aorta disease, including clinical manifestation, misdiagnosis, improper treatment and final definite diagnosis. Results All 9 cases were misdiagnosed as simple inferior limb thrombo-embolism at first. Three cases were treated with emergent thrombeetomy using Fogarty catheter. The correct diagnosis was achieved by 3-dimensional CT angiography （3DCTA） after operation, and the eitiology of other 6 cases were also proved as aortic disease by 3DCTA before operation. Among 5 cases of acute aorta dissection with iliac-femoral artery involved, 2 cases abandoned surgery with one dying the next day and the other lost to follow-up after being discharged. The other 3 cases were treated with endovascular therapy successfully. One case of abdominal aorta anurysm with mural thrombosis defluxion were treated by aneurysm resection. The other 3 cases of Leriche syndrome with acute aorta terminal filament thrombosis formation were cured by aortoiliac bypass. The limbs ischemia were improved in all cases without perioperative death. Conclusion Aorta diseases can sometimes lead to acute inferior limb ischemia, mimicking limb artery thrombo-embolism. Preoperative imaging especially 3DCTA helps to establish correct preoperative diagnosis for a successful treatment.

关 键 词：主动脉疾病 误诊 动脉瘤 夹层 主动脉瘤 动脉硬化闭塞症 

分 类 号：R686[医药卫生—骨科学]