经缩小额外侧入路治疗前循环动脉瘤的临床分析

目的:探讨经缩小额外侧手术入路治疗前循环动脉瘤的临床效果。方法:回顾性分析经缩小额外侧入路治疗45例前循环动脉瘤患者的临床资料。结果:45例共61个动脉瘤均成功显微手术夹闭。1例患者术后出现肺部感染,转入重症监护科继续治疗。其余患者出院时恢复良好40例,轻残4例,无1例死亡。结论:经充分的术前评估,运用熟练的显微手术操作技术,缩小额外侧入路治疗前循环动脉瘤疗效可靠。     

感染性心内膜炎多发心外并发症一例

感染性心内膜炎是由病原体感染心内膜所致,容易累及心脏瓣膜,其特征性病损为赘生物形成,而赘生物脱落可以引起动脉栓塞并造成重要组织器官的缺血、坏死等。中国人民解放军总医院确诊了1例感染性心内膜炎合并多发心外并发症,其特征性影像学表现为超声检查发现二尖瓣前叶赘生物形成,CT、MRI检查发现多发脏器、血管受累,具体表现为脾梗死、肾脏梗死、脑梗死、脾动脉瘤、肠系膜上动脉瘤、肾动脉瘤及右侧大脑中动脉远端管腔狭窄、闭塞。     

注射毒品致感染性股动脉假性动脉瘤35例血管修复体会

目的：探讨注射毒品致感染性股动脉假性动脉瘤的特点及血管修复重建方法。方法：回顾性分析2000年1月～2006年12月35例因注射毒品致感染性股动脉假性动脉瘤行血管重建治疗经过。采用腹股沟韧带上方切口，经腹膜后控制髂外动脉，并在动脉瘤远端暴露股浅动脉并控制，切除动脉瘤，均用人造血管重建。结果：20例患者经正常解剖途径作血管重建，其中，15例切口愈合不佳，11例在术后3个月人造血管感染，术后1年，10例人造血管闭塞；15例患者经解剖外途径作血管重建，其中，5例切口愈合不佳，6例在术后3个月人造血管感染，术后1年，5例人造血管闭塞。结论：经解剖外途径血管重建是治疗注射毒品致感染性股动脉假性动脉瘤较好的方法。     

颅内动脉瘤患者相关因素对开颅手术预后的影响分析

目的:探讨影响颅内动脉瘤开颅手术预后的相关因素,以期用来指导临床治疗。方法:分析我院自2005年6月～2011年12月收治的412例颅内动脉瘤开颅手术患者资料,统计分析年龄、性别、血糖、血压、Fisher's分级、手术时机、Hunt-Hess分级、白细胞升高程度、脑血管痉挛(cerebral vasospasm,CVS)、感染等因素对患者预后的影响程度。结果:CVS、Fisher's分级、Hunt-Hess分级、白细胞升高程度、感染是影响此类患者开颅手术预后的相关因素(P<0.01),Hunt-Hess分级与开颅手术预后呈线性负相关关系。结论:动脉瘤的开颅手术预后受多种因素影响,明确影响动脉瘤开颅手术预后的相关因素并采取相应措施,能提高动脉瘤的手术治疗效果。     

Bilateral popliteal aneurysms complicating adult polycystic kidney disease in a patient with a marfanoid habitus

A man born in 1944 presented with an episode of macroscopic haematuria during a urinary tract infection in 1988. He was unusually tall at 2 metres. An intravenous pyelogram and an abdominal ultrasound disclosed the presence of bilaterally enlarged polycystic kidneys and a polycystic liver. There was a family history of renal disease. Plasma creatinine (180 micro mol/l) and blood pressure (150/100 mm Hg) were both raised. Despite good blood pressure control his renal function declined progressively and he started renal dialysis treatment in 1995. He received a renal allograft in 1996. In 1994 he had noticed a painful swelling behind his left knee. Computed tomography with contrast showed a large popliteal aneurysm. This was replaced with a vein graft. The right popliteal artery showed milder changes, and this was repaired in 1999. Popliteal aneurysms develop most often in older vasculopaths with multiple risk factors; connective tissue disorders have rarely been associated with their presence in younger patients. Polycystic kidney disease has been associated with several aneurysms, most notably cerebral, but not popliteal. The patient's marfanoid habitus also may have played a part. This case emphasises the mixed aetiology of popliteal aneurysms.     

Early and late results of resection of abdominal aortic aneurysms.

Resection of the abdominal aortic aneurysm is being performed with decreasing operative mortality and morbidity. Among 190 patients undergoing this procedure at the Ottawa Civic Hospital between 1970 and 1975, 53 (28%) had a ruptured aneurysm and 137 (72%), a nonruptured aneurysm. Mean age of the patients was 66.2 years. Concomitant disease was frequent, 73% of patients having two or more associated diseases; the average number of associated diseases per patient was 2.25. Operative mortality in the group with ruptured aneurysms was 51%, and in the group with nonruptured aneurysms, 4%. Postoperative morbidity was 85% among those with a ruptured aneurysm, 67% among those with imminent rupture before operation and 34% among the others with a nonruptured aneurysm. Graft complications occurred in 15% of those with a ruptured aneurysm and 9% of those with a nonruptured aneurysm. Among survivors of the operation 73% and 81% of those with a ruptured and a nonruptured aneurysm, respectively, are known to be alive. In both groups causes of late death included infection or thrombosis of the graft and mesenteric thrombosis, as well as causes unrelated to the operation. Surgical management of the abdominal aortic aneurysm is advocated in all but patients at poor risk for operation who have asymptomatic aneurysms less than 6 cm in diameter.     

Acute rupture of a left ventricular false aneurysm

Left ventricular aneurysm develop when rupture of the free ventricular wall is contained by the inflammatory surrounding tissues. These false aneurysms rupture secondarily and should be treated soon after diagnosis. The diagnosis is suggested by echocardiography and confirmed by cardiac catheterization. Immediate surgery is recommended, with good survival in most reports. The patient presented in this report had ruptured his left ventricular false aneurysm before diagnosis. He was operated and had a good initial postoperative course. He died later from a severe pulmonary infection.     

Unusual causes of calf swelling--1. Unusual presentation of a tibial artery false aneurysm

Peripheral aneurysms of the leg are rare, and nearly always involve the popliteal artery. We describe the unusual presentation of a swollen leg caused by a large false aneurysm of a branch of the posterior tibial artery. This developed in the absence of either a history of trauma, local infection or infective endocarditis.     

Acute aneurysm surgery using three-dimensional CT angiogrphy without conventional catheter angiography

The object of this study is to assess whether aneurysm surgery can be performed in patients with ruptured cerebral aneurysms by using three-dimensional computerized tomography angiography (3D-CTA) alone, without conventional catheter angiography (CCA). Between May 1994 and November 1996, a consecutive series of 60 cases of ruptured cerebral aneurysms was evaluated by both 3D-CTA and CCA prospectively and compared the detectability of cerebral aneurysms. Both 3D-CTA and CCA demonstrated a 100% diagnostic accuracy of ruptured cerebral aneurysms. In the associated unruptured cerebral aneurysms, the diagnostic accuracies of 3D-CTA and CCA were 96% and 92%, respectively. Based on the results, we have operated on 128 consecutive patients with ruptured aneurysms in the acute stage based on 3D-CTA findings since December 1996. One hundred twenty eight ruptured aneurysms including 50 associated unruptured aneurysms were detected by 3D-CTA. In seven of 128 ruptured aneurysms, which included four dissecting vertebral artery aneurysms, two basilar artery (BA) tip aneurysms, and one BA-superior cerebellar artery (SCA) aneurysm, 3D-CTA was followed by CCA to obtain diagnostic confirmation or information concerning the vein of Labbé, which was needed to guide the surgical approach for BA tip aneurysms. All of the ruptured aneurysms were confirmed at surgery and treated successfully. One hundred twenty one patients who underwent surgery with 3D-CTA findings only had no complications related to the lack of information of CCA. The authors considered that 3D-CTA could replace CCA in the diagnosis of ruptured aneurysms and that surgery could be performed in almost all acutely ruptured aneurysms by using only 3D-CTA without CCA.     

经眉弓锁孔入路夹闭前循环破裂动脉瘤

目的探讨经眉弓锁孔入路手术夹闭大脑前循环破裂动脉瘤的技术及经验。方法回顾性分析我科经眉弓锁孔入路治疗前循环破裂动脉瘤的临床资料,领悟手术理念,总结手术时机、手术方法、操作技巧等方面的经验教训。结果 56例(59个)动脉瘤全部一次手术夹闭成功,均未出现手术入路相关并发症,其中4例术中有动脉瘤破裂出血,2例合并有脑积水并行脑室腹腔分流术,1例死于肺部感染及多脏器功能衰竭,52例患者出院6个月后复查DSA显示夹闭良好。结论眉弓锁孔入路显微外科手术是治疗前循环破裂动脉瘤的一种有效、安全的微创方法。     

经锁孔入路手术对合并颅内血肿前循环破裂动脉瘤患者临床可行性及安全性分析

目的 探讨经锁孔入路手术治疗合并颅内血肿前循环破裂动脉瘤的临床效果及安全性.方法 选择合并颅内血肿前循环破裂动脉瘤患者86例,随机分为观察组与对照组,每组43例.观察组行经锁孔入路动脉瘤夹闭+颅内血肿清除术治疗,对照组行开颅手术夹闭动脉瘤+颅内血肿清除术治疗.观察两组手术情况、患者术后并发症发生情况及患者恢复情况.结果...     

加强炎性动脉瘤认识与鉴别

炎性动脉瘤是指一类与动脉炎症病变相关的动脉瘤,绝大多数由风湿免疫疾病所致。炎性动脉瘤发病率低,表现隐匿,内科治疗为主,故病因诊断和鉴别尤为重要。当遇到年轻的动脉瘤患者,有发热,贫血,乏力,体重下降等非特异性表现及临床炎性指标如血沉、C反应蛋白等增高时,需高度警惕炎性动脉瘤可能。本文按系统性血管炎依血管大小分类的方法,介绍常见各种炎性动脉瘤的概念和发病情况,以备临床各科医生查阅。     

Percutaneous transfemoral endovascular repair of popliteal artery aneurysms

Popliteal artery aneurysms are the hallmark of peripheral aneurysms, accounting for 70%, and are commonly bilateral in 50% to 75% of patients. The prevalence and incidence of popliteal artery aneurysms are not precisely known. The presence of a popliteal aneurysm is a marker of risk to limb and life because 33% to 43% are associated with an abdominal aortic aneurysm. Ligation and bypass reconstruction has long been the "gold standard" for the treatment of popliteal aneurysms. Recently, endoluminal repair with a percutaneously delivered stent-graft has become a valid alternative to open repair. In this study, we illustrate two cases of a total of four patients with popliteal artery aneurysms treated with percutaneous stent graft placement and discuss overall management of these aneurysms. The other two patients had a successful early outcome (30 days), but long-term follow-up is still lacking.     

血管内支架成形术在脑动脉瘤栓塞治疗中的应用

[目的]探讨应用支架血管内重建栓塞治疗脑动脉瘤的可行性及临床效果。[方法]12例患者应用Neuroform支架及冠脉支架,动脉瘤的瘤颈宽度介于3-8 mm之间,瘤体与瘤颈直径之比均小于2.0。其中动脉瘤位于后交通动脉5个,颈内动脉床突上段4个,基底动脉顶端分叉部动脉瘤1个,椎基底动脉交界处梭形动脉瘤1个,基底动脉夹层动脉瘤1个。患者在围手术期均口服血小板抑制剂。[结果]12个支架均成功释放,1例患者在栓塞术后出现患侧大面积脑梗塞。5例患者在蛛网膜下腔出血当天行栓塞治疗,采用Neuroform支架联合弹簧圈栓塞;4例患者在蛛网膜下腔出血3 d之内行栓塞治疗;1例患者在出血后20 d行栓塞治疗;另1例患者在头外伤后1个月行栓塞治疗。本组患者死亡1例,11例患者出院时恢复良好。[结论]采用支架血管内重建联合弹簧圈治疗颅内宽颈动脉瘤、梭形动脉瘤及夹层动脉瘤是安全有效的,但长期疗效仍需大宗病例总结和长期随访研究。     

Abdominal aortic aneurysms: how can we improve their treatment?

Arteriosclerotic abdominal aortic aneurysms are present in a least 2% of the elderly population of the Western world and their number is increasing. Without treatment 30% of patients with asymptomatic aneurysms live for 5 years, although the risk of rupture becomes greater as the size of the aneurysm increases. Of those with untreated symptomatic aneurysms 80% are dead within a year. Elective repair of aneurysms has a low mortality, and 50% of the patients live for at least 5 years. Symptomatic aneurysms all cause pain and may produce other symptoms from pressure on adjacent structures, distal embolism, acute thrombosis or rupture. In 88% of cases an aneurysm can be diagnosed by physical examination alone; confirmatory tests include soft-tissue roentgenography of the abdomen, ultrasonography, computer-assisted tomography and aortography. Repair is indicated for symptomatic or ruptured aortic aneurysms and for asymptomatic aneurysms over 5 cm in diameter. Early diagnosis and referral for repair is essential for optimum treatment of this common condition.     

A case of deep femoral artery aneurysm found with superficial femoral artery aneurysm

Objective: Deep femoral artery (DFA) aneurysms are extremely rare cases of aneurysms that are difficult to diagnose. The objective of this report was to discuss the timing and method of surgery for this disease.Patient: We encountered an asymptomatic left DFA aneurysm that was discovered along with a symptomatic aneurysm of the right superficial femoral artery (SFA). Both sides of the aneurysm were resected with Dacron knitted artificial vascular grafts (Gelsoft™ Plus, Vasctek, UK) simultaneously.Result: After the operation, the right SFA had good blood flow, but the graft of the left DFA was occluded. The occlusion was considered to be caused by insufficient blood flow in the graft. The patient was discharged without any complications.Conclusion: The coexistence of DFA aneurysms should be examined if other aneurysms are found. DFA aneurysms are at a high risk of rupture. Careful follow-up is required, and intervention is recommended when the diameter exceeds 35 mm.     

SURGICAL TREATMENT OF INTRACRANICAL ANEURYSMS (A REPORT OF 55 CASES)

<正> Fifty-five patients with intracranial cerebral aneurysmswere directly operated on. Surgical management of this disease, characteristics of intracranial aneurysms, and technical key points in treatment of aneurysms are discussed.     

多层螺旋CT血管成像在颅内动脉瘤诊断中的价值

目的通过与三维数字血管减影（DSA）对比,评价64层螺旋CT血管成像（CTA）对颅内动脉瘤尤其是〈3 mm动脉瘤的诊断价值。方法选择怀疑有颅内动脉瘤的310例患者纳入研究,所有患者均行64层螺旋CTA和DSA检查。64层螺旋CTA技术参数：120 kV、250 mAs、准直0.75 mm、重建层厚0.75 mm和间隔0.4 mm。结果三维DSA作为诊断标准,在310例患者中,220例发现264个动脉瘤。CTA漏诊4个动脉瘤,7个动脉瘤在常规DSA检查中漏诊,但被64层螺旋CTA诊断,均得到三维DSA的证实。64层螺旋CTA诊断〈3 mm颅内动脉瘤的敏感性、特异性和准确性分别是94.0%、100.0%和97.9%。结论 64层螺旋CTA对于颅内动脉瘤包括〈3 mm动脉瘤是一种准确的影像学检查方法,可以作为颅内动脉瘤诊断的首选影像检查。     

The coagulopathy associated with aortic aneurysms

The authors in this article record their experience with eight-four patients with abdominal aortic aneurysms. Twenty-seven patients (32%) presented with ruptured aneurysms with an overall mortality of 56%. Of the unruptured aneurysms, 67% were operable with a mortality of 5.3%. The highest mortality amongst the patients with ruptured aneurysms was in the group who was shocked. In the group with ruptured aneurysms, of those in whom platelet counts were performed, 50% were abnormally low, and 56% had evidence of abnormal coagulation. Seventy per cent of those with coagulation abnormalities died. In the unruptured group 28.2% had thrombocytopenia but no other abnormalities of coagulation. All patients undergoint aneurysm resection should have a platelet count and a full clotting screen. Therapy should be directed to normalization of the coagulation system.     

64排螺旋CT血管造影VR成像与DSA在颅内动脉瘤诊断中的对比研究

目的探讨64排螺旋CT血管造影（computed tomography angiography，CTA）容积再现技术（volume rendering，VR）及数字减影血管造影（digital subtraction angiography，DSA）对颅内动脉瘤的不同诊断价值。方法对38例怀疑颅内动脉瘤的患者行CTA及DSA检查，CTA检查采用VR技术进行后处理，同时辅助最大密度投影技术（maximum intensity project，MIP），DSA常规行双侧颈动脉及椎动脉造影。观察对比两者对瘤体和瘤颈的大小、比率，分叶、分支毗邻的显示情况。 结果经CTA VR发现颅内动脉瘤35例共41个，经DSA检查证实颅内动脉瘤35例共42个。VR对颅内动脉瘤的敏感度为95.2%，特异度为100%，准确度为89.1%。容积重建成像能清晰显示颅内动脉瘤、形态、分支及与临近结构的关系，对于动脉瘤瘤体/瘤颈比也有准确的显示。 结论CTA VR成像可获得与DSA相近的检查结果，对了解颅内动脉瘤的三维结构和制定治疗方案有重要的辅助作用。将DSA与CTA技术结合将有利于更全面、准确地诊断和观察颅内动脉瘤。