医源性假性动脉瘤的诊断和治疗

为预防和提高医源性假性动脉瘤的诊治水平，对３１例医源性假性动脉瘤进行了回顾性分析。男２７例，女４例，年龄１１～７８岁，平均年龄４１．７岁。病程７小时～１３个月，平均５．８个月。２０例行择期手术，６例急诊手术，另行压迫治疗６例。手术治疗２６例均痊愈，包括压迫治疗者１例失败改行手术者；压迫疗法治愈５例。结论：医源性损伤已成为假性动脉瘤的主要原因，并且是可以预防的。假性动脉瘤的诊断并不困难，中小动脉外伤性动脉瘤无需特殊检查即可手术治疗，手术方式应根据病人的具体情况而定。对于动脉穿刺所致的假性动脉瘤的早期病例，压迫治疗可作为首选的治疗方式     

腹腔镜在肾囊肿治疗中的应用

１９９２年１２月～１９９５年１２月应用腹腔镜治疗单纯肾囊肿３１例。年龄２１～７２岁，平均５３岁。男１６例，女１５例。囊肿最大直径４．５～１１．４ｃｍ，平均７．７ｃｍ；左肾１７例，右肾１１例，双肾３例。肾上极６例，下极１２例，中部１２例，多发１例。手术采用经腹腔途径１９例，经后腹膜腔途径１２例。３１例全部治疗成功。手术时间１５～１８０分钟，平均８０分钟。其中经腹腔途径平均８５±３６分钟，经后腹膜腔途径平均６５±２５分钟。术后平均住院日３．６２±１．５３天，其中经腹腔组３．３９±１．３２天，经后腹膜腔组３．８０±１．３２天，术后随访１～３６（１７．１０±９．５５）个月，未见复发     

经皮穿刺髓核成形术治疗腰椎间盘突出症

髓核成形术（Nucleoplasty）首先在美国于２０００年７月用于临床治疗腰椎间盘突出症。本院自２００１年７月２０日引进该技术治疗腰椎间盘突出症１６例，临床上初步观察疗效满意。现报告如下。资料与方法１．一般资料：本组病例１６例，男９例，女７例；年龄在１８～６５岁（平均３７．４岁）；病程２～６７个月。全部病例具有腰部酸痛及下肢痛，１２例同时伴有下肢麻木和（或）感觉异常。其中L３～４段２例，L４～５段６例，L５S１段３例，L３～４、L４～５段３例，L４～５、L５S１段２例。２．手术步骤：术前所有患者均行腰椎间盘CT…     

小针刀在治疗颈性眩晕中的作用（附57例临床观察）

颈性眩晕是中老年人常见病症之一，病因复杂，疗效多不满意。病人头晕、头痛反复发作，十分痛苦。笔者对５７例颈性眩晕患者经牵引，药物离子透入，中医正骨手法等治疗症状改善不大者，用小针刀治疗，症状迅速缓解。现报告如下：１　临床资料５７例中，男２３例，女３４例；年龄２４岁～６７岁，３５岁～４５岁１６例占２６％，４５岁～６０岁３４例占５９．７％；病程１个月～７年，平均１年３个月。５７例Ｘ片均见有颈椎生理曲度改变。Ｃ４－８变直者１９例；Ｃ３～６椎体增生４２例，Ｃ４～８钩椎关节增生３３例，椎间隙狭窄者３５例；有…     

动脉瘤192例外科治疗体会

总结我院１９８４－１９９７年治疗的动脉瘤１９２例临床经验，方法回顾性分析外科治疗周围动脉瘤１０６例和肾下脉主动脉８６例的手术方式和疗效。结果本组１７５例接受手术治疗，手术治愈率９１．４％，手术病列死率２．３％，其中腹主动脉瘤３例劲动脉瘤１例，手术并发症发生率６．３％，包括吻合口假性动脉瘤７例，肢体远端有缺血症状４例。     

一期切除修补双侧肺大皰的护理

一期切除修补双侧肺大皰的护理江苏省南京市胸科医院赵敏杰我科１９９２年４月至１９９４年９月，一期手术治疗双侧肺大破裂、自发性气胸患者８例，手术效果良好。现将护理报告如下。１临床资料本组８例，男７例，女１例，年龄１７～１９岁，平均３０．３岁。有反复发作性...     

右外侧小切口剖胸小儿先天性心脏畸形矫治术319例体会

目的介绍经右外侧小切口剖胸体外循环下小儿心脏直视手术的经验。方法１９９４年１０月至１９９７年４月，共完成经右外侧第４或第３肋间进胸，体外循环下先天性心脏畸形矫治术３１９例。患儿年龄３．４４±１．５９岁（５个月～８岁），体重１３．６６±３．９８（６～２６）ｋｇ。修补房间隔缺损８７例（合并左上腔静脉１例，肺动脉瓣狭窄６例，部分肺静脉畸形引流５例），室间隔缺损２００例（合并动脉导管未闭７例，二尖瓣关闭不全７例，左上腔静脉３例，右室流出道狭窄１１例），法乐氏四联症１９例（合并左上腔静脉３例，单冠状动脉畸形１例），部分心内膜垫缺损２例及其他畸形１１例。体外循环时间平均５６．０７±２４．９０（２０～１７６）分，心肌循环阻断３２．９７±２０．３８（６～１４０）分。术后机械通气平均１８．７５±２４．５７（２～１４０．７２）小时，平均住院７．０８±０．６９（７～１７）天。结果全组患儿无手术死亡。结论这种切口可安全有效地替代正中剖胸矫治某些小儿常见的心脏畸形，它具有损伤小，瘢痕隐蔽，不破坏胸廓连续性，防止术后鸡胸等优点，其美观效果优于胸部正中或双乳腺下皮肤切口。     

中西医结合治疗结核性肛瘘10例

近几年来，笔者收治１０例结核性肛瘘，均经中药坐浴配合１％的异烟肼纱条换药治疗痊愈。１临床资料１０例病人中男性７例，女性３例。年龄最小１９岁，最大４７岁，平均年龄３３岁。病程２个月～２５个月。低位单纯性１例，低位复杂性３例，高位单纯性２例，高位复杂性４...     

雷公藤防治克隆病术后复发疗效观察

克隆病是一种原因不明的肠道慢性炎症性疾病，主要与自身免疫有关，其病程多迁延反复，常因并发肠梗阻及肠穿孔等而须经外科手术治疗，但术后常因再复发而须再次手术。我院自１９８８～１９９８年间对２５例克隆病术后病人采用雷公藤ＴⅡ进行治疗，疗效满意，报告如下。１　临床资料１．１　一般资料　治疗组男１８例，女７例。年龄１３～６３岁，平均４２岁。病程３个月～１２年，停药后复发７例，无１例再手术。对照组为１９８８年前病例。术后采用强的松治疗，男１１例，女９例，年龄１５～６２岁，平均４１岁。病程３个月～１０年，停药…     

肉芽肿性睾丸炎八例报告

肉芽肿性睾丸炎八例报告顾纪容，朱忠尧近１０年来收治８例肉芽肿性睾丸炎，报道如下。临床资料本组８例，年龄２２～６５岁，平均４７．６岁。病程１～１５个月，平均４．２５个月，已婚７例，未婚１例。３例有阴囊外伤史，全组均无泌尿系感染及输精管手术史，８例均接受...     

��Χ����ҽԴ�Լ��Զ�����22���������

??Treatment in limbs iatrogenic pseudoaneurysm??A report of 22 cases JIA Qi??WU Dan-ming??WANG Cheng-gang??et al. Department of Vascular Surgery, the People's Hospital of Liaoning Province,Shenyang110016,China
Corresponding author??WU Dan-ming??E-mail??danming_w@126.com
Abstract Objective To explore the clinical effect of the treatment in limbs iatrogenic pseudoaneurysm of different types. Methods A total of 22 cases of iatrogenic pseudoaneurysm in limbs admitted in the People’s Hospital of Liaoning Province from 2010 to 2013. According to the diameter of iatrogenic pseudoaneurysm and the size of tear, pseudoaneurysm were divided into??,??a,??b and ?? type??in which 15 cases were type I ( the diameter of pseudoaneurysm was less than 3cm)??treated with braking??elastic bandage. Two cases were type ??a ( the diameter of pseudoaneurysm was more than 3cm and the tear was less than 2cm)??treated with temporary block by balloon and injecting the thrombin into the blood vessel. Two cases were type??b ( the diameter of pseudoaneurysm was more than 3cm and the tear was more than 2cm) treated by endovascular repair with covered stents. Three cases were type ??(infectious pseudoaneurysm) treated by endovascular repair with covered stents. The first phase was debridement and drainage of abscess. The second phase was sewing up the wound. All the cases were followed up for 6 to 32 months. Results A total of 14 cases were successful for the all 15 cases of type I.The failure was treated by endovascular repair with covered stents. The cases of type?? were all successful. For the cases of type ??, the tear of pseudoaneurysm were all healed by first intention and cuts all healed well within three months. All the cases had an average follow-up of 22.3 months. No recurrence??no endoleaks, no stent migration??no fracture and other complications occurred. Conclusion Surgeons can treat pseudoaneurysm more effective with minimal cost??by choosing the treatment strategy based on the different types of pseudoaneurysm.     

周围动脉医源性假性动脉瘤22例诊治体会

目的 探讨采用不同方法治疗不同类型周围动脉医源性假性动脉瘤的临床效果。方法 辽宁省人民医院2010-2013年收治周围动脉医源性假性动脉瘤病人22例,根据假性动脉瘤直径及破口的大小及有无感染,将假性动脉瘤分为对Ⅰ、Ⅱa、Ⅱb以及Ⅲ型,15例Ⅰ型病人(假性动脉瘤直径<3cm)采用制动、弹力绷带加加压包扎治疗;2例Ⅱa型病人(直径>3 cm破口<２cm)采用球囊临时阻断,凝血酶腔内注射疗法治疗,2例Ⅱb病人（直径>3 cm且破口>2 cm）采用覆膜支架腔内隔绝术;3例Ⅲ型病人（感染性假性动脉瘤）采用覆膜支架腔内隔绝术,一期脓腔清创引流,二期缝合的办法,所有病人随访6～32个月。结果 Ⅰ型15例病人治疗成功14例,1例失败病人给予腔内覆膜支架植入术;Ⅱ型病人均一期封闭;Ⅲ型病人动脉瘤破口均一期封闭,伤口3个月内均愈合。所有病人平均随访22.3个月,无复发、内漏,支架移位、折断等并发症。结论 根据假性动脉瘤不同类型选择治疗的策略,可用最小的代价更有效地治疗假性动脉瘤。     

34例周围动脉假性动脉瘤的诊治

目的 探讨周围动脉假性动脉瘤（pseudoaneurysm,PSA）不同治疗方法及适应证。方法 回顾性分析1999年10月～2006年10月34例周围动脉PSA的临床资料、治疗方法和疗效。结果 34例周围动脉PSA分别采用超声引导下加压治疗（5例）、超声引导下凝血酶注射治疗（5例）和手术方法治疗（27例）。超声引导下加压治疗5例,成功3例,2例改手术治疗。超声引导下凝血酶注射治疗5例,成功4例,1例改手术治疗。手术治疗27例,其中直接修补术12例,自体静脉补片修补术3例,动脉端端吻合1例,血管缝扎7例,人造血管重建术1例,自体静脉重建术3例;1例直接修补术后20d复发再次行直接修补术成功,其余26例均手术成功。所有病例无死亡,无远心端缺血加重。治疗成功后,假性动脉瘤包块消失。随访3～36个月,平均15个月,无复发。结论 外科手术仍是治疗PSA的主要方法,按照适应症选择超声引导下加压治疗、超声引导下凝血酶注射治疗也能取得良好的疗效。     

Pseudoaneurysms of the ascending aorta following coronary artery bypass surgery

BACKGROUND: Ascending aortic pseudoaneurysms following prior cardiac procedures are a rare entity. We reviewed our institutional experience given the isolated case reports in the literature. METHODS: A 10-year retrospective review identified 5 patients who underwent ascending aorta pseudoaneurysm repair. There were 3 women and 2 men with a median age of 70 years (range 63 to 79 years). Median duration from initial CABG to pseudoaneurysm repair was 5 years (range 5 months to 18 years). The clinical presentations included dyspnoea (2 patients), chest pain, fever of unknown origin, and a pulsatile mass. Four patients underwent urgent investigation and surgery. Diagnosis was established via CT scan (3 patients), transesophageal echocardiogram (1 patient), and MRA (1 patient). Two patients had a prior history of sternal wound infection. RESULTS: Mortality was 60%. One survivor experienced a stroke. The etiology was prior cannulation site in 4 cases and vein graft anastamotic site in 1. Necrotic aortic tissue was noticed in 2 cases. Aortic tissue cultures were negative in all the patients. Cardiopulmonary bypass was established prior to sternotomy in 4 cases and 1 case was performed off-pump. Inadvertent rupture of the pseudoaneurysm (without exsanguination) occurred in 2 cases following sternotomy. Repair was performed with bovine pericardial patch in 2 cases and plication in 3 cases. CONCLUSION: This highlights the varied presentation, necessity for urgent diagnosis and repair with a high operative mortality due to the late presentation. Aggressive diagnosis should be sought and consideration should be given to catheter-based interventions for initial treatment.     

四肢动脉伤后合并缺血性肌挛缩分析

旨在分析四肢动脉损伤后合并缺血性肌挛缩的原因并讨论其预防措施。１９６０年～１９９５年收治的四肢动脉损伤２６９例，合并缺血性肌挛缩１９例，发生率为７．０６％。上肢５例，下肢１４例。月国动脉伤５１例中９例（１７．６％）发生缺血性肌挛缩。入院前１１例曾在他院手术处理，３例未探查处理血管，１例结扎，７例修复损伤动脉均失败；５例伴行静脉损伤，３例结扎。仅１例作了深筋膜切开术。受伤至来院时间：８～１４小时４例，３４～５７小时８例，１９天～１９个月７例。入院后１７例修复了损伤动脉。８例伴行静脉伤，５例修复，３例结扎。８例作深筋膜切开术。随访３个月～２８年（平均５年），修复的１７例动脉１６例通畅。１１例缺血性肌挛缩肢体作了矫形手术，外观及功能明显改善。证明，早期诊治、正确处理损伤动静脉和深筋膜切开术是预防缺血性肌挛缩的关键。月国动脉损伤是发生缺血性肌挛缩的最常见部位，应予认真处理。     

隐匿性血管损伤的临床特点与诊疗策略

目的 探讨临床骨科中隐匿性血管损伤的临床特点、诊断与治疗,以期提高对此类损伤的认识和临床诊治效率.方法 2003年3月至2010年10月共收治649例血管损伤患者,其中隐匿性血管损伤50例(7.7%),男42例,女8例;年龄13～66岁,平均34.0岁.血管损伤类型:静脉损伤1例,动脉损伤42例,动、静脉同时损伤7例.根据张英泽等提出的肢体动脉编码和损伤分型:A型14例,B型20例,C型16例.初始损伤至诊断时间平均为43.4 d(2～337 d),表现为肢体缺血、骨筋膜室综合征、血肿或假性动脉瘤、出血、神绛受压等征象.辅助检查包括:彩色多普勒超声17例,CT血管造影7例,X线血管造影25例.手术治疗43例,包括血管修补、直接吻合、自体静脉移植、结扎及截肢,其中2例术后行血液滤过治疗;内科治疗3例;介入栓塞治疗4例.结果 4例患者截肢后伤口愈合良好,无并发症发生;其余46例患者出院时患肢皮肤温度、颜色均恢复正常,远端动脉搏动存在,平均随访6.7个月(1～42个月),患肢血运良好.结论临床工作中的隐匿性血管损伤并非少见,其临床表现具有延迟出现、多种多样及不典型的特点.诊断方法应优先选择血管造影.治疗以手术为主,酌情采用血管内介入治疗和血液滤过治疗.

Abstract：

Objective To investigate clinical characteristics, diagnosis and treatment of insidious vascular injuries in orthopaedic cases. Methods Between March 2003 and October 2010, we treated 649 cases of orthopedic and vascular injuries, 50 (7. 7% ) of which were identified as insidious injuries. They were 42 men and 8 women, aged from 13 to 66 years (average, 34. 0 years). The insidious injury affected the vein in one case, the artery in 42 cases and both in 7 cases. The vascular injuries were categorized as type A (14 cases), type B (20 cases) and type C (16 cases) according to the classification system proposed by Zhang Ying-ze. The diagnoses were made after an average of 43. 4 days from primary injuries, with the assistance of color Doppler ultrasound in 17 cases, CT angiography in 7 and X-ray angiography in 25. Clinical manifestations included limb ischemia, compartment syndrome, hematoma or pseudoaneurysm, hemorrhage and nerve entrapment. Forty-three patients were treated by a variety of surgical options, such as angiorrhaphy, anastomosis, transplantation of autogenous venous graft, ligation and amputation. Among them, hemofiltration was performed in 2 cases as adjuvant therapy. Endovascular embolization was performed in 4 cases and conservative treatment in the other 3. Results Forty-six patients had their limbs salvaged, with normal temperature and color of the skin and existence of distal arterial pulses at discharge from hospital. The other 4 patients had to sustain amputation. An average follow-up of 6. 7 months (from one to 42 months) revealed that all the affected limbs regained normal blood circulation. Conclusions The insidious presentations and atypical clinical manifestations make diagnosis of insidious vascular injury very difficult. We recommend angiography as the first step in diagnosis. Surgical approaches should be considered as the main treatment choice, and hemopurification can be used as adjuvant therapy if necessary. In some cases, endovascular intervention may be faster and safer.     

Iatrogenic femoral artery aneurysms in orthopaedic practice

BACKGROUND: Iatrogenic injury to the femoral vessel is a rare complication after fracture of hip. Pseudoaneurysm formation of superficial femoral artery or profunda femoris artery is detected quite late. We present our experience for surgical management of pseudoaneurysm of femoral artery after iatrogenic trauma during management of fracture of femur. METHODS: A retrospective analysis was carried out for eight patients with femoral artery pseudoaneurysm treated surgically during the last 10 years in one surgical unit. RESULTS: Of eight patients with pseudoaneurysm of femoral artery, six had superficial femoral artery aneurysm and two profunda femoris artery aneurysm. Mean duration for presentation was 4 months (range 2-6 months). Methods of surgical intervention were direct closure of arterial defect after aneurysmectomy in six cases and use of saphenous vein patch graft for repair of artery in two cases. Mean size of aneurysm was 12 x 7 cm (range 8 x 4 cm to 20 x 12 cm). All patients were doing well during a mean follow up of 72 months (range 6-110 months). CONCLUSION: Large pseudoaneurysms of femoral arteries after iatrogenic injury during management of fractures of femur should be managed by aneurysmectomy and arterial repair with or without saphenous vein patch graft.     

注射吸毒致假性股动脉瘤的修复重建

目的 探讨注射吸毒致假性股动脉瘤的特点及修复重建外科治疗。方法 2000年5月～2005年5月，对15例因注射吸毒致假性股动脉瘤行急诊外科治疗。均为男性，年龄20～36岁。病程18～52d，平均35d。注射吸毒史3～17个月。左侧5例，右侧10例。患者均表现为腹股沟搏动性包块并出血，患侧大腿根部不同程度肿胀、疼痛致下肢活动受限。患侧足背动脉搏动消失或减弱。1例症状较轻者行彩色多普勒检查提示股动脉假性动脉瘤，余14例因瘤体破裂出血较多未行检查。其中行瘘口修补术1例，ePTFE人造血管移植14例，血管长5～20cm。结果 术后1例伤口愈合欠佳，经换药后3周痊愈，其余14例伤口Ⅰ期愈合。肢体均存活，患肢足背动脉搏动恢复或增强，肤色、皮温及毛细血管反应正常。术后3个月行彩色多普勒复查，人造血管通畅，无血栓形成及吻合口狭窄，下肢行走功能基本恢复，无跛行。结论 急诊手术彻底清创以及应用显微外科技术修复重建血管是治疗假性股动脉瘤的关键。     

Clinical features and management of splenic artery pseudoaneurysm: case series and cumulative review of literature

INTRODUCTION: Splenic artery pseudoaneurysm is uncommon. We report our institution's recent 18-year experience with these aneurysms and review the literature. METHODS: We reviewed the records for 37 patients with visceral artery pseudoaneurysm evaluated at our institution from 1980 to 1998. From this group we found only 10 patients (27%) with splenic artery pseudoaneurysm. We also reviewed 147 cases of splenic artery pseudoaneurysm reported in the English literature. RESULTS: In this series of 10 patients, 5 were men. Mean age was 51.2 years (range, 35-78 years). Causes of aneurysm included chronic pancreatitis in 4 patients, trauma in 2 patients, iatrogenic cause in 1 patient, and unknown cause in 3. The most common symptom was bleeding in 7 patients and abdominal or flank pain in 5 patients; 2 patients had no symptoms. Aneurysm diameter was known for four pseudoaneurysms, and ranged from 0.3 to 3 cm (mean, 1.7 cm). Splenectomy and distal pancreatectomy were performed in 4 patients, splenectomy alone in 2 patients, endovascular transcatheter embolization in 2 patients, and simple ligation in 1 patient. One patient with a ruptured pseudoaneurysm died before any intervention could be performed; there were no postoperative deaths. Follow-up data were available for 7 patients, with a mean of 46.3 months (range, 4.5-120 months). CONCLUSIONS: Splenic artery pseudoaneurysm is rare and usually is a complication of pancreatitis or trauma. Average aneurysm diameter in our series of 10 patients was smaller than previously reported (1.7 cm vs 5.0 cm). Although conservative management has produced excellent results in some reports, from our experience and the literature, we recommend repair of all splenic artery pseudoaneurysms.