CAJ | 학술논문

目的探讨假性动脉瘤的部位、类型和发生原因,选择不同的治疗方法.方法对21例假性动脉瘤患者(四肢动脉11例、脾动脉3例、肾动脉2例、髂总动脉2例、髂内动脉1例、胆囊动脉1例、阴茎动脉1例)选择不同的治疗方法,9例肢体动脉近大关节处假性动脉瘤采用球囊临时阻断血流下瘤体切除、血管吻合术或直接切开修补术,4例主干型假性动脉瘤采用覆膜支架腔内隔绝术,其中2例发生于髂内动脉开口处的髂总动脉主干型假性动脉瘤采用分支动脉栓塞和覆膜支架腔内隔绝术,6例终末型假性动脉瘤采用明胶海绵结合不锈钢圈栓塞术.结果 21例假性动脉瘤采用不同的方法治疗后瘤腔全部消失,11例肢体动脉假性动脉瘤患者术后远端血管搏动正常,未出现神经损伤,2例脾动脉主干近端、2例髂总动脉主干假性动脉瘤覆膜支架隔绝术后无内漏、远端血流通畅,6例终末型假性动脉瘤患者栓塞后瘤腔消失,出血停止,未出现脏器缺血坏死,其中1例髂内动脉二级分支多发假性动脉瘤患者,栓塞后1周因骨盆复合伤并发重度感染死亡.结论根据假性动脉瘤的部化、类型和产生原因,选择不同的治疗方法,在尽量小的创伤下使各部位假性动脉瘤得到有效的治疗.
목적 탐토가성동맥류적부위、류형화발생원인,선택불동적치료방법.방법 대21례가성동맥류환자(사지동맥11례、비동맥3례、신동맥2례、가총동맥2례、가내동맥1례、담낭동맥1례、음경동맥1례)선택불동적치료방법,9례지체동맥근대관절처가성동맥류채용구낭림시조단혈류하류체절제、혈관문합술혹직접절개수보술,4례주간형가성동맥류채용복막지가강내격절술,기중2례발생우가내동맥개구처적가총동맥주간형가성동맥류채용분지동맥전새화복막지가강내격절술,6례종말형가성동맥류채용명효해면결합불수강권전새술.결과 21례가성동맥류채용불동적방법치료후류강전부소실,11례지체동맥가성동맥류환자술후원단혈관박동정상,미출현신경손상,2례비동맥주간근단、2례가총동맥주간가성동맥류복막지가격절술후무내루、원단혈류통창,6례종말형가성동맥류환자전새후류강소실,출혈정지,미출현장기결혈배사,기중1례가내동맥이급분지다발가성동맥류환자,전새후1주인골분복합상병발중도감염사망.결론 근거가성동맥류적부화、류형화산생원인,선택불동적치료방법,재진량소적창상하사각부위가성동맥류득도유효적치료.
Objective To study the locations, types and causes of different pseudoaneurysms in order to find out the optimal individualized treatment for different pseudoaneurysms. Methods Different methods were applied in treating 21 patients with pseudoaneurysm, which were located at limb (n = 11 ), spleen (n =3), kidney (n = 2) , common lilac artery (n = 1), internal iliac artery (n = 1), gallbladder (n = 1) and penis (n = 1 ). Different managements were employed in treating these pseudoaneurysms. Temporary obstruction of blood circulation with balloon together with arterial anastomosis or direct incision neoplasty was performed in 9 cases with pseudoaneurysms at limb arteries close to the larger joints. Endovascular stent graft was used to isolate the trunk type of pseudoaneurysm in 4 cases, in 2 of them branch arterial embolism and stent graft endovascular exclusion were applied as they had common iliae artery trunk type of pseudoaneurysm at the opening of internal iliac artery. Gelfoam together with metallic coils embolization was employed in 6 cases with terminal type of pseudoaneurysms. Results After different treatments, tumor cavities disappeared in the 21 cases with pseudoaneurysms. Distal arterial pulse returned to normal and no nerve damage occurred in 11 cases with limb pseudoaneurysms. No internal hemorrhage was observed and distal blood circulation returned to normal after graft endovascular exclusion in 2 eases with pseudoaneurysms at spleen artery trunk and in 2 cases with pseudoaneurysms at iliac artery trunk. In 6 cases with terminal type of pseudoaneurysms,the tumor cavity disappeared, hemorrhage stopped and no ischemic necrosis of organ occurred. But one of them with multiple traumatic pseudoaneurysms located at the second grade branch died one week after embolism due to a serious pelvic trauma accompanied with serious infection. Conclusion Based on the locations, types and causes of pseudoaneurysms, different individualized treatment should be adopted in order to obtain optimal results with least damages.