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。

Experience on the diagnosis and treatment of 34 cases of peripheral pseudoaneurysm

Objective To investigate the treatment methods and indications for peripheral pseudoaneurysm. Methods Clinical data of 34 cases of peripheral pseudoaneurysm from October 1999 to October 2006 were retrospectively reviewed. Results Different treatment methods were employed in the 34 cases, including ultrasound guided compression repair in 5 cases (succeed in 3 and failed in 2), ultrasound guided thrombin injection in 5 cases (4 were cured and a surgical treatment was needed in 1), and surgical treatment in 27 cases (direct repair in 12 cases, autogenous vein patch plasty in 3, arterial end-to-end anastomosis in 1, arterial transfixion in 7, artificial blood vessel reconstruction in 1, and autogenous vein reconstruction in 3). Out of the 28 cases, one case suffered from recurrence on the 20th day after the primary direct repair, and was cured by a re-operation. No deaths or aggravated ischemia of distal limbs happened. After treatment, the impulsive lumps disappeared. All the cases were followed for 3~36 months (mean, 15 months), and no recurrence was noted. Conclusions Surgical operation is still the major treatment for peripheral pseudoaneurysm. In addition, ultrasound guided compression repair and ultrasound guided thrombin injection could also exert satisfactory curative effects.