白塞氏病导致动脉瘤的外科治疗

目的总结白塞氏病动脉瘤的外科治疗经验,并对其手术方式和药物治疗进行探讨。方法1977年4月～2004年12月收治的7例白塞氏病所致动脉瘤患者中,主动脉弓降部假性动脉瘤4例,右锁骨下动脉假性动脉瘤1例,右腋动脉假性动脉瘤1例,胸腹主动脉多发性假性动脉瘤1例。施行瘤体切除破口补片修补术4例,瘤体切除人工血管置换术1例,带膜支架腔内隔绝加左右腋动脉搭桥术1例,瘤体切除右锁骨下动脉结扎术1例。结果无住院死亡。术后吻合口动脉瘤形成1例,其它部位动脉瘤形成2例,股动脉插管后发生闭塞1例,移植物闭塞1例。随访1～12个月(平均5.7个月),死亡4例,其余3例存活。结论白塞氏病导致动脉瘤术后易发生吻合口动脉瘤和/或形成新的动脉瘤或动脉瘤破裂,根据病变部位的不同选择不同的处理方法,结合药物综合治疗可以取得较好的效果,其中人工血管置换术较补片修补术效果好。

Surgical Treatment of Aneurysm in Behcet''''s Disease

Objective To summarize the outcome in surgical management and medical therapy of aneurysm involved in Behcet's disease. Methods From April 1977 to December 2004,7 patients (one female) were admitted. There were 4 false aneurysms in aortic isthmus, and 1 right subclavian artery pseudoaneurysm, and 1 right axillary artery false aneurysm, and 1 thoracicoabdominal multiple pseudoaneurysms. Surgical procedures included 4 aneurysmorrhaphys and patch angioplasties, 1 aneurysmorrhaphy and tube graft replacement, 1 covered stents and axillary to axillary artery bypasses, 1 aneurysmorrhaphy and right subclavian artery ligation. The other 3 cases survived. Results There were no hospital death, but there were 1 anastomotic aneurysm occurrence, 2 new aneurysms formation, 1 femoral artery occlusion at canal insertion site, and 1 bypass graft occlusion. Follow-up from 1 to 12 months, there were death in 4 cases. Conclusions Behcet's disease could easily result in anastomotic aneurysm and/or new aneurysm or rupture occurrence. Based on location of lesion, selection of proper intervention, and combination with immunosuppression therapy, the satisfactory result could be obtained, therein, prosthetic graft replacement surpasses the patch angioplasty.