载瘤动脉切除结合血管移植重建血运治疗上肢假性动脉瘤  

Aneurysm excision combined with vascular graft revascularization as treatment for upper limb pseudoaneurysm

作　　者：毛炳焱[1] 唐举玉[1] 吴攀峰[1] 王文聪[2] 贺用礼[2] 胡志喜[2] 王强[2] 丁原[2] 熊荣华[2] 

机构地区：[1]中南大学湘雅医院骨科,长沙410008 [2]常德,长沙医学院附属石门医院

出　　处：《中华手外科杂志》2014年第6期455-457,共3页Chinese Journal of Hand Surgery

摘　　要：目的 探讨载瘤动脉切除结合血管移植重建血运治疗上肢假性动脉瘤的临床疗效.方法 2008年9月至2013年6月收治上肢假性动脉瘤患者23例,其中外伤9例,尿毒症血液透析血管损伤12例,介入操作损伤2例;肱动脉损伤11例,桡动脉损伤10例,尺动脉损伤2例.采用显微外科技术,切除瘤体及载瘤动脉,同时取大隐或小隐静脉血管移植重建患肢血运.结果 23例手术均获得成功,无围手术期死亡病例.随访时间为6～24个月,平均12.3个月,术后搏动性肿块消失,无假性动脉瘤复发,患肢重建血运良好,肢体远端未出现缺血坏死,1例患者伤口延迟愈合.结论 临床体征、血管彩色超声等均能明确诊断上肢假性动脉瘤.应尽早手术治疗,避免因破裂大出血导致死亡,载瘤动脉切除结合血管移植重建血运方法是治疗上肢假性动脉瘤的较好手术方式.Objective To investigate the clinical outcomes of treating upper extremity pseudoaneurysm using aneurysm excision combined with vascular graft revascularization.Methods Twenty-three cases of upper limb pseudoaneurysm treated between September 2008 and June 2013 were involved.The cause of the pseudoaneurysm was trauma in 9 cases,vascular injury from uremia hemodialysis in 12 cases,and vascular injury from interventional procedures in 2 cases.The vessels affected were brachial artery in 11 cases,radial artery in 10 cases,and ulnar artery in 2 cases.The pseudoaneurysm along with its parent artery was resected microsurgically.The lesser or greater saphenous veins were harvested as grafts to reconstruct the resected vessel segrnent for limb revascularization.Results All 23 procedures were successful.There was no peri-operation period death.The patients were follow-up for 6 to 24 months with an average of 12.3 months.Postoperatively the pulsating mass disappeared.There was no recurrence of the pseudoaneurysm.Perfusion of the affected limbs was good.No distal limb ischemia and necrosis occurred.Delayed wound healing was noted in 1 case.Conclusion Diagnosis of upper extremity pseudoaneurysm can be made based on clinical signs and vascular color Doppler ultrasound.Once diagnosed,it should be surgically treated as soon as possible to avoid death resulted from aneurysm rupture and massive bleeding.Resection of the pseudoaneurysm along with its parent artery combined with vascular graft for revascularization is a good option for the treatment of upper limb pseudoaneurysm.

关 键 词：假性动脉瘤 外科手术 移植 载瘤血管 

分 类 号：R654.4[医药卫生—外科学]