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目的报告1例儿童颈内动脉颅外段巨大梭形动脉瘤的诊治结果,并复习相关文献以提高对该病的认识。方法患儿女性,13岁,以“左颈部搏动性包块1年,突然增大2个月”为主诉入院,既往无颈部外伤、感染病史。入院查体:左颈部近下颌角处可见一3.5cm×6cm包块,随脉搏搏动,听诊无血管杂音。DSA、CTA检查示左颈内动脉起始段至近颅底处呈囊袋状扩张,边缘完整。术中见颈内动脉动脉瘤呈梭形,长约6cm,最大径约3cm,将动脉瘤切除后用人工血管(内径6mm)与颈内动脉两断端行端端吻合架桥保持颈内动脉通畅。结果病理检查见动脉壁增厚,纤维组织增生并粘液变性、玻璃样变性及慢性炎细胞浸润,局部钙化。术后患儿恢复良好,无并发症。术后随访2年CTA及彩超检查左颈内动脉形态、走行正常、管腔内血流通畅。结论儿童颈内动脉颅外段动脉瘤十分少见,其常见病因主要有动脉粥样硬化、感染、外伤及继发于颈内动脉内膜剥脱术后等,临床表现为无痛性颈部搏动性包块,可引起脑缺血或动脉瘤破裂致颈部大出血等严重并发症,治疗方法有切除后用自体或人工血管重建或血管内放置支架等。
Objective To report the diagnosis and treatment of a huge fusiform aneurysm of the extracranial segment of the internal carotid artery in children and to review the relevant literature to improve its understanding of the disease. Methods Children and adolescents, aged 13, were admitted to the hospital with “left neck pulsatile massaging for 1 year and sudden increase for 2 months.” There was no previous history of neck trauma or infection. Admission examination: the left neck near the mandibular angle can be seen a 3.5cm × 6cm mass, with pulse beating, auscultation without vascular murmur. DSA, CTA examination showed the beginning of the left internal carotid artery to the proximal skull at the pocket-like dilatation, edge complete. Arteria intracranial artery aneurysm surgery was fusiform, about 6cm, the maximum diameter of about 3cm, after the removal of the aneurysm with artificial blood vessels (diameter 6mm) and two ends of the internal carotid artery end-to-end anastomosis of the bridge to maintain the internal carotid artery unobstructed. Results Pathological examination showed thickening of arterial wall, fibrosis and mucus degeneration, degeneration of glassy and chronic inflammatory cell infiltration, local calcification. Postoperative recovery of children with no complications. Follow-up 2 years after CTA and color Doppler ultrasound examination of left internal carotid artery morphology, normal walking, lumen flow within the lumen. Conclusion The extracranial aneurysms of internal carotid artery are very rare in children. The most common causes are atherosclerosis, infection, trauma and secondary to internal carotid artery endarterectomy. The clinical manifestations include painless neck pulsatility Mass, can cause cerebral ischemia or aneurysm rupture caused by severe bleeding in the neck and other complications, treatment of resected with autologous or artificial vascular reconstruction or intravascular placement of stents and so on.