CAJ | 학술논문

目的：回顾总结28例四肢假性动脉瘤的临床特点及随访疗效。方法应用显微外科技术治疗四肢假性动脉瘤28例，其中采用瘤体切除及动脉壁修补术4例、瘤体切除及动脉端端吻合术8例、瘤体切除及血管移植术16例(其中自体大隐静脉移植10例、头静脉移植4例、人造血管移植2例)。结果28例手术修复均获成功。3例伤口进行游离植皮的患者中2例一期愈合、1例部分植皮坏死、经换药2周后再次植皮成活。随访1～10年(平均5年零8个月)，临床及超声波检查均显示修复动脉通畅且无假性动脉瘤复发。自体静脉移植的患者中有10例2年后超声波检查显示移植静脉轻度扩张，但无动脉瘤形成。有邻近神经发生受压症状的6例患者，在假性动脉瘤切除和动脉修复手术后6个月左右症状均消失，未造成患肢的功能障碍。结论外伤造成的动脉损伤是假性动脉瘤最常见的原因，医源性损伤所致有逐渐增多的趋势。对假性动脉瘤要尽早治疗，尽可能进行血管修复。彩色多普勒、超声波对假性动脉瘤的诊断帮助，MRI 和血管造影可明确诊断。
목적：회고총결28례사지가성동맥류적림상특점급수방료효。방법응용현미외과기술치료사지가성동맥류28례，기중채용류체절제급동맥벽수보술4례、류체절제급동맥단단문합술8례、류체절제급혈관이식술16례(기중자체대은정맥이식10례、두정맥이식4례、인조혈관이식2례)。결과28례수술수복균획성공。3례상구진행유리식피적환자중2례일기유합、1례부분식피배사、경환약2주후재차식피성활。수방1～10년(평균5년령8개월)，림상급초성파검사균현시수복동맥통창차무가성동맥류복발。자체정맥이식적환자중유10례2년후초성파검사현시이식정맥경도확장，단무동맥류형성。유린근신경발생수압증상적6례환자，재가성동맥류절제화동맥수복수술후6개월좌우증상균소실，미조성환지적공능장애。결론외상조성적동맥손상시가성동맥류최상견적원인，의원성손상소치유축점증다적추세。대가성동맥류요진조치료，진가능진행혈관수복。채색다보륵、초성파대가성동맥류적진단방조，MRI 화혈관조영가명학진단。
Objective To retrospectively summarize the clinical features and follow-up effects of 28 cases of pseudoaneurysms in limbs. Methods The microsurgical technique was used in the treatment of 28 patients with pseudoaneurysms in limbs. Among them, 4 patients were treated with pseudoaneurysms resection and artery repair, 8 patients with pseudoaneurysms resection and end to end artery anastomosis and 16 patients with pseudoaneurysms resection and autogenic vein transplantation, including 10 patients with autotransplantation of great saphenous vein, 4 patients with cephalic vein graft and 2 patients with artiifcial blood vessel transplantation. Results The operation was successfully performed on all 28 patients. The wound healing by ifrst intention occurred in 2 of the 3 patients treated with free skin grafting. A patient with partial necrosis underwent skin grafting again and survived 2 weeks after the dressing. The mean follow-up period was 68 months ( range;1-10 years ). The clinical and ultrasound examinations showed the repaired artery was patent and no recurrence of pseudoaneurysms was found. Two years later, the ultrasound examination revealed mild venous dilatation in 10 of the patients with autogenic vein transplantation, but no aneurysms were noticed. At 6 months after the pseudoaneurysms resection and repair operation, the symptom disappeared in 6 patients with adjacent nerve compression, and limb dysfunction did not occur. Conclusions Pseudoaneurysms are most commonly resulted from the artery injuries caused by trauma, but the iatrogenic false has gradually increased. The early treatment and vascular repair can ensure the satisfactory effects. The color Doppler ultrasound plays an important role in the diagnosis of pseudoaneurysms, and the Magnetic Resonance Imaging ( MRI ) and angiography help clarify the diagnosis.