腹腔镜胆囊切除术后假性动脉瘤的诊治

目的:探讨腹腔镜胆囊切除术(LC)后假性动脉瘤的诊治方法。方法:对4例LC术后假性动脉瘤患者的临床资料进行分析,对其诊治要点及预防措施进行探讨。结果:4例患者主要临床表现包括右上腹痛、上消化道出血、黄疸等,彩色多普勒超声检查提示诊断,选择性血管造影明确诊断并同时行栓塞治疗成功,均治愈。结论:彩色多普勒超声和选择性血管造影是本病的主要诊断方法。介入栓塞治疗应作为假性动脉瘤治疗的首选方法。假性动脉瘤的形成与手术操作有关,应重在预防。     

Arterial and pseudoaneurysm ruptures complicating liver transplantation

Ruptures of the hepatic artery and hepatic pseudoaneurysms (PA) are rare but serious complications of hepatic transplantation. We conducted a retrospective study of 640 liver transplantations performed in our institution for a variety of pathologies. After surgery, seven major arterial bleeds occurred (0.9%). Of these seven cases, there were due to hepatic artery rupture (HAr) and four to PA rupture; all confirmed at either surgery (six cases) or autopsy (one case). Five of the seven patients died. In all cases the transplantation was difficult. All vascular injuries but one were caused by sepsis and occurred either after an undetermined cause septicemic syndrome (five cases) or graft dysfunction (one case). The last vascular injury was biliary drainage related. Six of the seven patients had imaging studies. Sonography (five cases) found a sub-hepatic hypoechoic collection in three cases but failed to do so in two. Duplex doppler (three cases) failed in all three cases to demonstrate a PA. Computed tomography (three cases) showed one PA, one perihilar sub-hepatic collection and failed in one. Conventional angiography (three cases) depicted a PA in all three cases. At the present time, our practice is to perform systematic angiography in patients with undetermined cause septicemic syndrome to research a PA. And if angiography is normal, to then puncture systematically any sub-hepatic collection to determine the bacteriological nature of this collection. Correspondence to: H. Caillet     

锁骨下动脉损伤及创伤性假性动脉瘤手术方法探讨

目的探讨锁骨下动脉损伤及创伤性动脉瘤的外科治疗方略。方法1991—2005年对2例锁骨下动脉损伤，6例锁骨下假性动脉瘤根据病变的部位、程度及受伤时间、累及范围等选择手术入路，采用血管缝扎、血管壁修补、血管吻合、血管移植、辅助体外循环及球囊止血技术实施手术。结果6例痊愈，1例动静脉狭窄，1例动脉闭塞伴臂丛损伤。平均失血800mL。结论锁骨下动脉损伤及假性动脉瘤手术复杂，术前对病变进行仔细评估，选择合理的切口及手术方法是减少并发症的关键。     

Femoral Pseudoaneurysm in Drug Addicts—Excision without Revascularization is a Viable Option

PURPOSE: To present a series of patients presenting with femoral pseudoaneurysm. RESULTS: Seventeen patients who presented with a femoral pseudoaneurysm during a 1 year period were included in this study. Parenteral drug abuse was the most common aetiological factor. The femoral artery was most commonly involved at its bifurcation. Sixteen patients (94%) had excision of the pseudoaneurysm with ligation of vessel and debridement without any revascularization and one patient (6%) had reverse saphenous grafting after excision and ligation of vessels. Four amputations (23%) were performed. Three (17%) were major limb amputations, which included one above knee and two below knee amputations. Four patients (23%) developed intermittent claudication. CONCLUSION: Excision of the pseudoaneurysm with ligation of vessels and wide debridement without immediate revascularization in infected pseudoaneurysms is a safe and effective treatment.     

Computed tomography of complications caused by manufacturing defects in synthetic grafts

Two unusual cases of delayed synthetic graft complications resulting from manufacturing defects of knitted Dacron are presented. Computed tomography appears to be a suitable noninvasive alternative examination to angiography in this condition.     

Bilateral traumatic caroticocavernous fistulae: total resolution following unilateral occlusion

Balloon occlusion is the accepted treatment for direct post-traumatic caroticocavernous fistula. We present a case of bilateral traumatic fistulae associated with a pseudoaneurysm. Resolution of both fistulae occurred following treatment of one of them by balloon occlusion of the internal carotid artery. This case highlights the importance of considering a more conservative approach to bilateral fistulae or those associated with a pseudoaneurysm. We review other treatment options. Received: 1 October 1999/Accepted: 20 October 1999     

Delayed pseudoaneurysm formation of the carotid artery following the oral cavity injury in a child: A case report

BACKGROUNDAn impalement injury of the oral cavity is a common traumatic injury in children. In most cases, it is not accompanied by sequelae, but if foreign body residues are not found due to a minor injury, they may result in inflammatory responses and delayed vascular injuries in the surrounding tissues. Without early diagnosis and appropriate initial management, residual foreign bodies can cause serious complications and even mortality in some cases. CASE SUMMARYA 9-year-old boy suffered an intra-oral injury by a wooden chopstick, and the patient was discharged from the hospital after receiving conservative treatment for the injury. However, the patient was readmitted to the hospital due to intra-oral bleeding, and since neck hematoma and right internal carotid artery pseudoaneurysm formation were detected on computed tomography, emergency surgery was performed. A remnant fragment of a wooden chopstick was found during the operation, and a delayed rupture of the internal carotid artery caused by the foreign body was also found.CONCLUSIONThe failure of early detection and diagnosis of a residual foreign body may result in delayed vascular rupture.     

Rupture from cavernous internal carotid artery pseudoaneurysm 11 years after transsphenoidal surgery

Carotid artery pseudoaneurysm is a rare complication of transsphenoidal surgery, usually diagnosed within 90 days post procedure. Sequelae of pseudoaneurysm rupture, such as severe epistaxis or carotid cavernous fistula (CCF), have significant morbidity and mortality. A case of epistaxis from pseudoaneurysm rupture over a decade after transsphenoidal surgery is presented, with staged treatment using coiling, endonasal mucosal flap repair and interval flow-diverting stent insertion. This case illustrates that pseudoaneurysm rupture occurs regardless of time course after transsphenoidal surgery, and treatment strategies using combined endovascular and endonasal techniques are reviewed.