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11例腘动脉瘤的诊断与治疗

血管外科·临床研究【文章编号】1007-9424(2006)06-0656-03 11例腘动脉瘤的诊断与治疗

马玉奎* 赵纪春* 汪 静* 金立人*

【摘要】 目的 对我院诊治的腘动脉瘤病例进行总结。方法 查阅我院1975~2004年11例腘动脉瘤患者病历,对其资料进行分析。结果 本组患者11例、患肢11条,常见的临床表现依次为腘窝搏动性肿块、跛行、伸膝

困难、肿块疼痛等,动脉瘤破裂3例(27.3%)。接受的特殊检查有动脉造影、彩色多普勒。10例行手术治疗,手术

方式包括:动脉瘤内缝合修补术4例;动脉瘤切除、血管移植术6例。病理结果:假性动脉瘤3例、梅毒性动脉瘤3例、动脉粥样硬化性动脉瘤4例。1例动脉瘤内缝合修补术后出现患侧小腿干性坏疽而行患侧大腿下1/3截肢

术。1例全身情况太差而未接受手术者死于心功能衰竭、晚期梅毒。术后随访1.5~30年,另外3例接受动脉瘤内缝合修补术患者中1例有间歇性跛行;1例患肢足背动脉能扪及搏动,无肢体缺血表现;1例失访。6例接受动脉瘤切除、血管移植术患者中,1例失访(Dacro n人造血管移植);1例有间歇性跛行;4例患肢足背动脉能扪及搏动,无肢体缺血表现。结论 推广彩色多普勒在人群筛查中的应用可能有助于腘动脉瘤的检出。有症状的腘动脉瘤及直径大于3cm的无症状腘动脉瘤应接受手术,直径小于或等于3cm的无症状腘动脉瘤可定期随访观察。

【关键词】  腘动脉瘤  诊断  治疗

【中图分类号】R654.4   【文献标识码】A

Diagnosis and Treatment of Popliteal Aneurysm:Report of11Cases MA Y u-k ui,ZH AO J i-chun,W AN G J ing,J IN

L i-ren.Department o f General S urgery,West China Hospita l,S ichuan Univ ersit y,Chengd u610041,China 【Abstract】 Objective T o present and summarize the data co ncer ning the diagnosis and treatment of po pliteal aneury sm in our hospital.Metho ds The data of po pliteal aneury sm in o ur ho spital f rom1975to2004w ere reviewed and analyzed.Eleven patients with11diseased limbs w ere trea ted,including8males and3females,ag e f rom21 y ear s to64y ear s〔(48.54±13.66)y ear s〕.T he combined diseases include syphilis,rheumatic hear t disease and chr onic obstructire pulmonary disea se e tc.T en patients receiv ed ope ratio ns,including endo aneury smor rhaphy (n=4)and g raft by pass af ter aneury smal r esectio n(n=6),thro ug h po ste rio r approach(n=7)or medial approach (n=3).O ne patient,combined w ith adv anced sy philis and heart failure,receiv ed conserva tive trea tment because o f his po or general conditio n.Results T he commo n clinical manifestatio ns included po pliteal pulsating mass,claudica-tion,difficulty in ex tensio n o f the knee,pain e tc.Acute ischemia occurred in3limbs.T he diame te r of po pliteal a n-eury sms varied fr om4-13cm〔(6.73±2.69)cm〕.Ther e w ere3(27.3%)cases o f ruptured aneury sms w ho se di-ameter s w ere7cm,7cm and11cm respectiv ely.Special examinations included ar te rio g raphy and D oppler sonog ra-phy.Patholog ical results of these patients we re pseudoaneurysm(n=3),sy philitic aneur ysm(n=3)and athe ro-scle rotic aneury sm(n=4).T w o patients w ere no t fo llow ed up,and po sto per ative fo llow up of the o the r8patients ranged fro m18mo nths to30y ear s.In the g ro up of endo aneury smor rhaphy,postopera tive g ang rene of the affected limb occurr ed in one patie nt,and abo ve-knee amputatio n w as perfo rmed.O ne patient suffe red fr om inter mittent claudication in the g ro up o f endoa neury smo rr ha phy and o f g raft by pa ss respectiv ely.N o manifestations o f limb is-chemia we re found in the o ther5patients during the time of follo w up.C onclusion G eneral utiliza tion o f Do pple r so no g raphy in screening high risk patients mig ht be helpful to detec t popliteal aneur ysm.F or sy mpto matic po pliteal aneury sm o r asy mptomatic popliteal aneury sm with diameter larg er than3cm,opera tion is indicated.A sympto matic po pliteal aneury sm s no mo re than3cm in diameter could be mo nito red w ith care.

【Key words】  Po pliteal aneury sm  Diag no sis  T rea tment

  腘动脉瘤的定义是腘动脉永久性扩张,直径超

 【作者单位】*四川大学华西医院普外科(成都610041)

 【作者简介】马玉奎(1971年-),男,四川省崇州市人,医学博士,主治医师,主要从事血管外科及肝胆胰外科工作。过2cm或其近侧正常动脉直径的150%[1]。它可引起下肢慢性缺血,也可发生破裂、血栓形成、远处动脉栓塞等急诊情况,威胁肢体甚至生命。国外关于该病的诊断与治疗的报道较多,是外周动脉瘤中

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·中国普外基础与临床杂志2006年11月第13卷第6期 Chin J Bases C lin General Su rg,Vol.13,No.6,Nov.2006