手术治疗颅外段弓上动脉瘤的单中心经验  

Single Center Experience in Surgical Treatment of Extracranial Supra-Aortic Aneurysms

作　　者：杨根欢 廖鹏志 刘新农 汪岩[1] 贾玉龙[1] 沈晨阳 YANG Genhuan;LIAO Pengzhi;LIU Xinnong;WANG Yan;JIA Yulong;SHEN Chenyang(Department of Vascular Surgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院血管外科,北京100070

出　　处：《中国医学科学院学报》2024年第4期554-559,共6页Acta Academiae Medicinae Sinicae

摘　　要：目的探讨手术治疗颅外段弓上动脉瘤的临床疗效并总结其治疗经验。方法收集首都医科大学附属北京天坛医院血管外科2019年5月至2023年11月收治的10例颅外段弓上动脉瘤患者的临床资料,其中颈内动脉瘤5例、锁骨下动脉瘤2例、椎动脉瘤2例、颈内动脉瘤合并同侧锁骨下动脉瘤1例。回顾性分析颅外段弓上动脉瘤的手术指征、手术策略、临床疗效及相关并发症。结果10例患者均顺利完成手术,手术时间60~420 min,中位手术时间180.0(121.5,307.5)min。术中出血30~400 mL,中位出血量90(50,125)mL。颈动脉阻断时间10~20 min,中位阻断时间15.0(11.5,16.3)min。椎动脉阻断时间20~30 min,中位阻断时间25.0(15.0,22.5)min。围手术期均无心脏意外、脑梗死及脑出血发生。10例患者获随访3~58个月,中位随访时间8.5(5.3,17.0)个月。1例锁骨下动脉瘤患者术后20个月出现人工血管闭塞。1例颈内动脉瘤患者术后6个月出现远端颈内动脉狭窄。结论颅外段弓上动脉瘤应积极采取手术治疗,需根据不同的病变情况采取个体化的手术策略。Objective To evaluate the effect of surgical treatment on extracranial supra-aortic aneurysms and summarize the experience.Methods The clinical data of 10 patients undergoing surgical treatment of extracranial supra-aortic aneurysms from May 2019 to November 2023 in the Department of Vascular Surgery of Beijing Tiantan Hospital affiliated to Capital Medical University were collected.The 10 patients included 5 patients with internal carotid artery aneurysm,2 patients with subclavian artery aneurysm,2 patients with vertebral artery aneurysm,and 1 patient with internal carotid artery aneurysm combined with ipsilateral subclavian artery aneurysm.The surgical indications,surgical regimens,clinical efficacy,and complications were retrospectively analyzed.Results All the 10 patients underwent surgery successfully,with the surgery duration range of 60-420 min and the median surgery duration of 180.0(121.5,307.5)min.Intraoperative bleeding volume varied within 30-400 mL,with a median of 90(50,125)mL.The time of carotid artery blocking and vertebral artery blocking varied within the ranges of 10-20 min and 20-30 min,with the medians of 15.0(11.5,16.3)min and 25.0(15.0,22.5)min,respectively.No cardiac accident,cerebral infarction,or cerebral hemorrhage occurred during the perioperative period.The 10 patients were followed up for 3-58 months,with the median follow-up time of 8.5(5.3,17.0)months.One patient with subclavian artery aneurysm developed artificial vessel occlusion 20 months after surgery.One patient with internal carotid artery aneurysm developed distal carotid artery stenosis 6 months after surgery.Conclusion Surgical treatment should be actively adopted for extracranial supra-aortic aneurysms,and individualized surgical regimens should be designed according to patient conditions.

关 键 词：弓上动脉瘤 颈动脉瘤 椎动脉瘤 锁骨下动脉瘤 手术治疗 

分 类 号：R654.3[医药卫生—外科学]