髂股动脉区域非创伤性动脉瘤患者的外科治疗  

Surgical treatment of non-traumatic aneurysm in ilio-femoral arterial region

作　　者：张晶虹[1] 胡海地[1] 常青[1] 冯勇[2] 段志泉[1] 辛世杰[1] 

机构地区：[1]中国医科大学附属第一医院普通外科研究所血管甲状腺外科,沈阳110001 [2]中国医科大学盛京医院外科

出　　处：《中华医学杂志》2011年第42期2959-2962,共4页National Medical Journal of China

基　　金：辽宁省自然科学基金（20042065）

摘　　要：目的探讨髂股动脉区域非创伤性动脉瘤的诊治经验。方法回顾性分析中国医科大学附属第一医院1985年1月至2010年11月61例髂股动脉区域非创伤性动脉瘤患者的临床资料。结果本组髂动脉瘤29例，股动脉瘤32例，共有髂股动脉区域动脉瘤76个，其中43个髂动脉瘤和33个股动脉瘤；17例（27．9％）为多发性动脉瘤，8例（13．1％）发生髂动脉瘤或股动脉瘤破裂，4例（6．6％）合并动脉硬化闭塞症。本组中50例择期行动脉瘤切除、人工血管或自体血管移植；7例破裂性动脉瘤急诊行动脉瘤切除、血运重建术，另1例抢救无效死亡；1例髂动脉瘤行腔内修复和1例髂内动脉瘤行栓塞术；1例髂动脉瘤保守治疗。1例股动脉瘤术后因急性动脉血栓形成导致下肢缺血、坏死而截肢，其余未发生围手术期下肢及盆腔脏器缺血等并发症。随访期间7例死亡，存活患者移植血管通畅，无新生动脉瘤形成。结论髂股动脉区域的非创伤性动脉瘤重在早期诊断和治疗，并注意多发性动脉瘤。动脉瘤切除及血运重建可获得良好疗效，术后应长期随访，观察有否新生动脉瘤。Objective To summarize the surgical experiences of treating 61 cases of non-traumatic aneurysms in ilio-femoral arterial region. Methods The clinical data of 61 consecutive patients with nontraumatic aneurysms in ilio-femoral arterial region between January 1985 and November 2010 were retrospectively reviewed. Results There were a total of 76 non-traumatic aneurysms in ilio-femoral arterial region, including solitary iliae aneurysms （ n = 29 ） and femoral aneurysms （ n = 32）. Seventeen （ 27.9% ） patients had muhiple aneurysms, 8 （13. 1%） patients ruptured aneurysms and 4 （6. 6% ） patients coexistent peripheral vascular occlusive disease. Fifty patients underwent electively aneurysm excision and graft （or autogenous vein ） replacement. Seven patients with ruptured aneurysms received emergency treatment. And one with multiple aneurysms died intra-operatively from ruptured iliac aneurysm. One patient with common iliac aneurysm underwent endovaseular repair without endoleak and 1 with internal iliae aneurysm received embolization. There was no perioperative mortality. But one with femoral aneurysm underwent amputation due to acute thrombosis. Seven patients died during the follow-up period and the survivors remained stable and had a good graft patency without new aneurysm formation. Conclusion Early management of aneurysms in ilio-femoral arterial region is rather important and multiple aneurysms should be considered. Aneurysm excision and arterial reconstruction yield an excellent outcome. Close and long-term follow-up is mandatory for the detection of new aneurysm formation.

关 键 词：髂动脉 股动脉 动脉瘤 非创伤性 外科治疗 

分 类 号：R654.3[医药卫生—外科学]