白塞病合并动脉瘤的治疗策略.DOCVIP

临床医学论文-白塞病合并动脉瘤的治疗策略 ???????????? 作者：杨宝钟 吴庆华 韩延民 陈忠 霍昕 【摘要】 目的? 结合诊治白塞病合并动脉瘤/假性动脉瘤初步体会，探讨对该病的治疗策略。 方法? 本组患者均为青壮年男性，具有典型的白塞病的临床表现。因反复动脉瘤及假性动脉瘤形成，共接受8次外科手术治疗。其中，2例患者手术前、术后针对原发病予以药物治疗（糖皮质激素、免疫抑制剂），1例患者自始至终对原发病未进行任何处理。 结果? 对原发病进行药物干预，待急性期过后再行手术治疗的患者，疗效满意;对原发病未行任何治疗即急于外科手术者，随访期间动脉瘤/假性动脉瘤频繁发生，疗效甚差。 结论? 白塞病合并（假性）动脉瘤在治疗上尚有很多问题未解决，关键要提高对该病的认识，切勿忽视原发病的治疗。应严格掌握治疗原则及手术技巧，并对每一位患者进行定期随访。 ??? 关键词? 白塞病 动脉瘤/假性动脉瘤 治疗 ??? Therapeutic options for Behcets disease combined with aneurysm ?????? 【Abstract】 Objective To study the therapeutic options for Behcets disease combined with aneurysm through our experience and literature review.Methods All patients in this group underwent8operations for recurrent a-neurysm and/or pseudoaneurysm formation.2patients received medical treatment（glucocorticoid and immuno impres-sion agent）before and after operation，1patient was not treated for primary disease during the course of illness.Re-sults The patients treated medically before and after operation gained satisfactory therapeutic result，while the patients operated without any medical intervention had poor therapeutic outcome with recurrent aneurysm and pseudoaneurysm formation.Conclusion Many problems remain unresolved with regard to the treatment of Behcets disease combined with aneurysm and/or pseudoaneurysm formation.Recognition of this entity and proper pre-and post-operative man-agement for the primary disease is of great importance.Surgical principle and techniques should be emphasized，and follow-up for each patient should be recommended. ??? Key words Behcets disease aneurysm/pseudoaneurysm treatment ??? 白塞病是一种以复发性口腔黏膜和（或）外阴溃疡、皮肤损害及眼部病变为主要特征的慢性炎症性系统性血管炎。该病不但可累及消化系统、神经系统、运动系统，还可累及动脉血管 ［1］ ，导致（假性）动脉瘤的反复发生。临床上极易忽视原发病，造成处理不当。为提高对本病的认识，笔者就诊治3例白塞病合并动脉瘤的初步体会报告如下。 ??? 1 临床资料 ??? 例1:男，36岁，入院前半年左腹股沟区出现搏动性肿物，逐渐增大，伴疼痛1个月。动脉造影提示左股总动脉瘤，约4cm×4cm大小，瘤腔内少量附壁血栓。在连续硬膜外麻醉下行左股动脉瘤切除、自体大隐静脉间置移植术。术中发现瘤体及其近端有炎症反应，与周围组织有轻度粘连。病理检查提示动脉内膜纤维性增厚，中层有慢性炎症及弹力纤维破坏，外膜纤维性增厚及慢性炎症，滋养血管周围有大量淋巴细胞、少量浆细胞及单核细胞浸润。术后2周痊愈出院。5个月后因左腹股沟原手术切