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骶髂螺钉植入术后臀上动脉假性动脉瘤形成二例

外伤性主动脉弓部破裂巨大假性动脉瘤形成腔内修复术一例

VASCULAR RECONSTRUCTION OF INFECTED PSEUDOANEURYSM IN 17 DRUG ADDICTS

Objective To evaluate surgical treatment of infected pseudoaneurysm (PA) caused by injection of addictive drugs. Methods The clinical data of 17cases of infected PA caused by drug injection were reviewed retrospectively. Ofthem, 1 case was female, and the other 16 cases were male, aging 24-38 years. The locations were brachial artery in 1 case and femoral artery in 16 cases. Fourteen cases were treated by artificial blood vessel transplantation after resection of the aneurysm and radical debridement, 1 case by amputation for serious infection, and 2 cases by non-operation for different reasons. Results Among 14 cases treated by prosthetic grafts, 13 cases achieved satisfactory results, no blood drawback of lower extremity occurred after operation; 1 case had to be amputated for serious infection. After 3 months of operation, the color Doppler examination showed that the 9 artificial vessel grafts were patent and the pulse of arteria dorsal pedis was good. Conclusion Though artificial vessel grafting has high risk in the vicinity of infected PA, it is still an effective procedure for revascularization in condition that there is no suitable autogenous conduit available for auto transplantation. Sufficient drainage, anti-infection and anti-coagulation therapy should be the key factors after the operation.

股骨粗隆间骨折内固定术后并发股深动脉假性动脉瘤一例

目的总结1例股骨粗隆间骨折内固定术后并发股深动脉假性动脉瘤诊治体会。 方法2011年10月收治1例摔伤致右侧股骨粗隆间骨折的女性患者，年龄78岁。入院后采用股骨近端防旋髓内钉（proximal femoral nail antirotation，PFNA）行骨折复位内固定术。术后第9天出现患侧大腿疼痛并逐渐加重，血红蛋白降低。第13天B超检查示右大腿前侧包块。急诊行右下肢超选择性血管造影术，示股深动脉第2穿支远端假性动脉瘤形成。用弹簧圈行第2穿支动脉栓塞术。 结果栓塞术后患侧大腿疼痛明显减轻，肿胀逐渐消退，顺利出院。患者获随访2年，右股骨粗隆间骨折完全愈合，患侧髋关节功能Harris评分为优。 结论股骨粗隆间骨折内固定术后如出现不明原因患侧大腿疼痛、肿胀、血红蛋白进行性下降等，应警惕假性动脉瘤的发生，行选择性血管造影术明确并选择相应治疗方法。

股动脉穿刺后假性动脉瘤的超声诊断与治疗

目的评价彩色多普勒超声在股动脉穿刺后股动脉假性动脉瘤形成的诊断及治疗中的临床应用价值。 方法回顾性分析2011年1月－2013年11月10例股动脉穿刺后假性动脉瘤形成的彩色多普勒超声声像图表现，总结在超声引导下对假性动脉瘤进行压迫治疗的操作方法，并对治疗结果追踪复查。 结果10例患者超声均查见股动脉周围无回声团块或混合回声团，并在瘤体内查见涡流血流信号及破口处出现“双期双向”血流频谱。10例假性动脉瘤患者行超声引导下压迫治疗，7例1次按压成功，3例重复多次按压成功。 结论彩色多普勒超声诊断假性动脉瘤准确率高，是首选的检查方法。超声引导下压迫治疗股动脉穿刺后假性动脉瘤，是一种有效的治疗方法，可以作为首选。

Application of MRA and DSA on Diagnosis of Traumatic Pseudoaneurysm and Arteriovenous Fistula (Report of 1 Case)

目的 提高对创伤性假性动脉瘤并动静脉瘘的影像诊断水平。 方法 报告1例腰椎间盘手术所致的创伤性假性动脉瘤并动静脉瘘，比较分析MRA和DSA对该病的诊断价值。 结果 MRA能够明确创伤性假性动脉瘤及动静脉瘘的诊断，与DSA有良好的相关性。 结论 MRA对创伤性假性动脉瘤并动静脉瘘的确诊有重要价值，在一定程度上能够代替常规血管造影。

注射毒品致股动脉假性动脉瘤破溃感染的治疗

目的 总结注射毒品致股动脉假性动脉瘤破溃感染的外科治疗方法。方法 1994年3月～2004年10月，共收治因毒品注射致股动脉假性动脉瘤形成并破溃感染患者17例。男15例，女2例；年龄18~45岁。吸毒史2个月~10年，静脉注射史吸毒2~15个月，皮肤坏死1~6个月。皮肤坏死直径2~5cm，B超示包块大小15cm×10cm×8cm~18cm×13cm×10cm。急诊手术4例，择期手术13例。3例行人造血管移植，5例行远近端血管结扎，5例行静脉移植，2例动脉裂口直接缝合，2例行股深动脉移植。结果 术后可触及足背动脉搏动恢复2例，增强3例。切口Ⅰ期愈合6例，Ⅱ期愈合8例，3例出现伤口感染。15例获随访3～18个月，2例同侧大隐静脉远端移植及2例人造血管移植者经B超检查示移植血管栓塞，5例血管腔(1例人造血管、2例自体静脉移植、2例动脉裂口直接缝合)变狭窄。随访者均基本恢复正常生活。结论 注射毒品致股动脉假性动脉瘤形成并破溃感染患者，需手术治疗，争取择期手术，针对假性动脉瘤破溃时间超过1个月者，可考虑行远近端血管结扎术。

Experience of Infected Pseudoaneurysms of Femoral Artery Caused by Drug Injection

目的探讨毒品注射所致感染性假性动脉瘤的特点及治疗方法与临床疗效。方法回顾性分析我院血管外科2009年1月至2010年6月期间收治的13例感染性假性动脉瘤吸毒患者的临床资料，采用切除瘤体及周围炎性组织、瘤腔清创及动脉结扎或人工血管置换术，观察移植效果及并发症发生情况。结果13例手术均获成功，无一例发生肢体坏死； 伤口一期愈合5例，二期愈合8例； 7例发生程度不等的淋巴瘘。随访2～12个月（平均7个月），其中1例术后2个月瘤腔下端感染形成脓肿伴出血，行切开引流痊愈； 2例术后4个月人造血管感染行人造血管摘除，切口换药痊愈； 有2例左肘部假性肱动脉瘤直接行血管结扎，未用人工血管移植； 余8例复查B超显示移植血管通畅，无血栓形成。结论彻底清创、血管移植、控制感染是治疗感染性假性动脉瘤的有效方法。

覆膜支架治疗难治性股动脉假性动脉瘤的探讨

目的探讨覆膜支架置入治疗难治性股动脉假性动脉瘤的有效性及其安全性。方法2012 年 8 月至 2017 年 8 月期间，河西学院附属张掖人民医院血管外科共收治了 26 例难治性股动脉假性动脉瘤患者，其中属外伤性股动脉假性动脉瘤 20 例，医源性股动脉假性动脉瘤 6 例；26 例中有 8 例合并股动-静脉瘘。26 例患者术前全部经彩超检查得以确诊，并在彩超引导下进行常规压迫或瘤腔内注射血凝酶治疗，但均未获成功，26 例患者最终改行股动脉覆膜支架置入术治疗，其中 4 例同期行血肿清除术，2 例行假性动脉瘤腔内穿刺引流术。结果全部患者一期置入覆膜支架均获成功，股动脉假性动脉瘤及动-静脉瘘均治愈，6 例患者股深动脉封闭，无手术死亡及严重并发症发生。术后 6 个月及 12 个月进行随访，26 例患者均无瘤体复发及支架移位、断裂、栓塞和内瘘发生。结论覆膜支架置入治疗难治性股动脉假性动脉瘤是安全、有效、微创的方法，其短期效果满意，远期疗效有待进一步观察。

IgG4 sclerosing cholangitis misdiagnosed as hilar cholangiocarcinoma and MDT discussion on postoperative gastrointestinal hemorrhage

ObjectiveTo explore clinical manifestation, diagnosis and treatment of IgG4 sclerosing cholangitis developed postoperative gastroduodenal hemorrhage, so as to improve awareness and treatment of this disease. MethodThe clinical data of a case of IgG4 sclerosing cholangitis misdiagnosed as the hilar cholangiocarcinoma which developed postoperative gastrointestinal hemorrhage in this hospital were analyzed retrospectively. ResultsThis patient was misdiagnosed as the hilar cholangiocarcinoma and accepted the radical resection, while the postoperative pathology proved to be the IgG4 sclerosing cholangitis. One month later, the patient developed the acute gastrointestinal hemorrhage and it was resolved by using the endovascular embolization. ConclusionsPreoperative distinguishing IgG4 sclerosing cholangitis from hilar cholangiocarcinoma can avoid an unnecessary surgery. Endovascular intervention is both a useful measure of diagnosis and treatment for gastroduodenal pseudoaneurysm. Attention should be paid to arterial protection during process of arterial osteogenesis in hepatobiliary operation.