腘动脉瘤外科及腔内治疗19例报告  

Analysis of clinical diagnosis and treatment of popliteal aneurysm surgery and endovascular treatment

作　　者：刘硕[1] 陈忠[1] 王盛[1] 唐小斌[1] 寇镭[1] 吴章敏[1] 刘晖[1] 杨燎[1] 陈东[2] 宋妍婷 LIU Shuo;CHEN Zhong;WANG Sheng(Department of Vascular,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;不详)

机构地区：[1]首都医科大学附属北京安贞医院血管外科,北京100029 [2]首都医科大学附属北京安贞医院病理科,北京100029

出　　处：《中国实用外科杂志》2022年第9期1031-1035,共5页Chinese Journal of Practical Surgery

基　　金：北京市科技计划课题(No.Z191100008319010)。

摘　　要：目的分析腘动脉瘤外科及腔内治疗的策略与方法。方法回顾性分析首都医科大学附属北京安贞医院2000年8月至2020年8月收治的19例腘动脉瘤病人临床资料。分析比较各病人的一般情况、围手术期情况及随访情况。结果19例病人中,外科修复16例,其中行腘动脉瘤切除+间质移植术7例,行腘动脉瘤旷置+旁路移植术9例。覆膜支架腔内修复术3例。2例围手术期深静脉血栓形成予抗凝治疗,1例吻合口出血急诊再次手术。30 d围手术期无心脑血管意外、死亡发生。4例失访,15例随访12~144个月,1例病人术后1年行截趾术,因感染重度性休克死亡。2例旁路移植病人出现切口周围麻木,营养神经治疗后好转。1例旁路移植病人术后1年复查桥血管再狭窄(50%),无下肢缺血症状出现。余病人下肢症状改善明确,无下肢缺血症状。结论治疗指征明确的腘动脉瘤应积极手术。外科重建或腔内修复是安全有效的,个体化的治疗策略选择可获得更满意的治疗效果。外科重建应作为腘动脉瘤治疗的首选。腔内修复的手术选择仍需非常谨慎。Objective To analyze the strategy and method of surgery and endovascular therapy of popliteal aneurysm.Methods A retrospective review of all patients with popliteal aneurysm between Aug 2000 and Aug 2020 was carried out in Beijing Anzhen Hospital,Capital Medical University.19 patients were included with clinical data.The general condition,perioperative condition and follow-up were analyzed and compared.Results Of the 19 patients,16 cases were treated with surgical repair.7 cases were performed the aneurysmectomy with interposition grafting and other 9 cases were treated by standard bypasses with aneurysm ligation.Another 3 cases were performed endovascular repair with stent grafts.2 cases suffered deep vein thrombosis(DVT)and treated with anticoagulant therapy Perioperatively and one anastomotic bleeding happened during the perioperative period and were performed bypass again.No death or cardiocerebrovascular accident 30 days after procedure.Four cases lost to follow-up and the follow-up time from 12 months to 144 months for other 15 cases.During the follow-up:one performed the toe amputation 1 year after procedure and suffered death caused by severe septic shock;2 cases who treated by standard bypasses got numbness around incision and have improvement in symptoms after trophic neurotherapy;another patient who performed standard bypass got 50%restenosis in bypass graft 1 year after procedure without symptoms in lower limbs;all other cases got improvement in lower limb symptoms during follow up.Conclusion The popliteal aneurysm with clear indication should be treated surgically.Either open surgeries or endovascular repair are all safe and effective and individualized treatment strategy can cause more satisfied results.Open repair should be considered as the standard first-line treatment for the popliteal aneurysms and endovascular repair should be carefully considered when treated popliteal aneurysms.

关 键 词：腘动脉瘤 外科重建 腔内修复 

分 类 号：R6[医药卫生—外科学]