复合手术治疗急性下肢缺血性腘动脉瘤  

Hybrid operation for the treatment of popliteal aneurysm with acute lower extremity ischemia:preliminary results

作　　者：秦永林[1] 柏志斌[1] 邓钢[1] 方文[1] 滕皋军[1] 

机构地区：[1]南京东南大学附属中大医院介入与血管外科,210009

出　　处：《介入放射学杂志》2012年第11期902-906,共5页Journal of Interventional Radiology

基　　金：江苏省自然科学基金资助项目(BK2010395);东南大学自然科学基金预研基金(KJ2009388);科技部博士点新教师基金(9290002458)

摘　　要：目的探讨复合手术治疗急性下肢缺血性腘动脉瘤的早期疗效。方法 2004年8月至2007年6月收治合并急性下肢缺血的腘动脉瘤患者7例,采用外科手术与血管介入相结合的复合手术方式进行治疗。复合手术包括传统的手术切除,结合手术前后置管溶栓、球囊扩张、术中球囊导管取栓等。方法观察围手术期并发症及早期治疗效果并对相关文献进行分析。结果外科手术包括动脉瘤旷置术2例,动脉瘤切除术5例。动脉瘤切除后重建方法包括人工血管置换术6例,自体动脉端端吻合1例。血管介入包括手术前后球囊扩张及置管溶栓7例,1例行术中取栓。围手术期无严重并发症,术后1周的踝肱指数较术前明显改善(0.68～0.98比0.22～0.52,P<0.001)。术后随访人工血管通畅,动脉瘤远近端侧支循环保留,肢体感觉及运动功能良好。结论复合手术保留了侧支循环,可以降低术后肢体远端缺血的风险;介入方法的使用保证了术后流出道的通畅,有助于避免术后移植物急性闭塞,从而有效降低术后截肢率。Objective To evaluate the early effect of hybrid operation in treating popliteal aneurysms with acute lower extremity ischemia. Methods During the period from Aug. 2004 to June 2007, seven patients with popliteal artery aneurysms complicated by acute lower extremity ischemia were treated with surgical operations together with interventional therapy, which included intraluminal thrombectomy with Fogarty catheter, pereutaneous transluminal angioplasty, thrombolysis, etc. The perioperaive complications and early clinical effect were recorded, and the results were analyzed. The relevant medical literature was reviewed. Results The surgical management included exclusion technique （n = 2） and aneurysmectomy （n = 5）. The vascular reconstruction after the resection included vascular replacement with prosthetic graft （n = 6） and end-to-end anastomosis of the vascular incision （n = 1）. Transluminal thrombolysis and percutaneous angioplasty were employed in all patients, and thrombectomy was performed in one patient. After hybrid operation, radiological imaging showed that the graft and distal arteries were patent, and the ankle-brachial index increased significantly （P 〈 0.001）. No severe complications occurred in the perioperative period. Conclusion For the treatment of popliteal aneurysms with acute lower extremity isehemia, hybrid operation is an effective option as this technique can reserve the collateral circulation and reduce the risk of distal artery ischemia. The use of interventional management can ensure the patency of the out- flow tract after the operation, which is extremely helpful in avoiding acute thrombosis in graft and, as a result, effectively reducing the amputation rate.

关 键 词：腘动脉瘤 外科手术 介入治疗 

分 类 号：R654.4[医药卫生—外科学]