儿童肱动脉假性动脉瘤一例并文献复习

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目的:报道1例儿童肱动脉假性动脉瘤的诊疗,并回顾相关文献总结此类疾病的病因、诊治及预后。方法:回顾性分析了2019年6月1例16天新生儿的左上肢肱动脉假性动脉瘤的临床资料。本例患儿出生后6d发现逐渐增大的左肘部包块。B型超声、左上肢MRI及CTA提示左肱动脉假性动脉瘤。经局部加压包扎治疗,包块持续增大并出现表面皮肤坏死渗液,遂在全麻下行假性动脉瘤切除+肱动脉端端吻合术。并通过PubMed、Springer Link、Google Scholar、Embase、Ovid、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方和维普数据库检索,总结儿童肱动脉假性动脉瘤的诊疗经验。结果:术后左上肢远端皮肤红润,毛细血管充盈实验1~2 s。24 h后拔除引流片,伤口愈合良好,术后14 d拆线。肘关节及左手活动自如。术后超声检查示左上肢远端桡尺动脉血流灌注良好。随访3个月,左上肢循环良好,活动自如。检索文献发现22篇中英文文献,对其报道的24例患儿诊疗情况分析,发现肘部血管针刺采血是最常见的致伤机制,占62.5%(15/24)。其次为肱骨髁上骨折,肱动脉被骨折端或是克氏针刺伤,占20.8%(5/24)。主要治疗方法是手术切除假性动脉瘤,占75%(18/24),并重建血管。预后良好,文献报道病例无远端肢体坏死情况。结论:儿童肱动脉假性动脉瘤较为少见,在婴幼儿多因肘部血管穿刺采血所致。较小的假性动脉瘤可尝试局部加压或瘤内凝血酶注射,无效则应切除假性动脉瘤并重建肱动脉。“,”Objective:To explore the diagnosis and management of a neonate of brachial artery pseudoaneurysm caused by brachial artery puncture and to conduct a contemporary review of the literature to better understand the natural history of this rare injury.Methods:Clinical data were retrospectively analyzed for a 16-day-old neonate with brachial artery pseudoaneurysm of left upper limb in June 2019. A gradually expanding mass of left elbow was found at Day 6 after birth. Type B ultrasound, magnetic resonance imaging (MRI) and computed tomography angiography (CTA) of left upper limb revealed a pseudoaneurysm of left brachial artery. After local compression bandaging, the mass continued expanding with surface skin necrosis and exudation. Then pseudoaneurysm resection plus brachial artery end-to-end anastomosis were performed under general anesthesia. The diagnostic and therapeutic experiences of brachial artery pseudoaneurysm in children was summarized by searching the databases of PubMed, Springer Link, Google Scholar, Embase, Ovid, Chinese Biomedical Literature (CBM), Chinese National Knowledge Infrastructure (CNKI), WanFang and VIP.Results:After surgery, distal skin of left upper limb became ruddy and capillary filling test was performed for 1 to 2 s. Drainage film was removed 24 hours later, wound healed well and stitches were removed at 14 days postoperatively. Elbow and left hand moved freely. Postoperative ultrasonography showed good blood perfusion in distal radioulnar artery of left upper limb. After 3-month follow-ups, left upper limb circulated well and moved freely. Twenty-two Chinese and English reports were retrieved and their managements were analyzed. Vascular acupuncture blood sampling at elbow was the most common mechanism of injury, accounting for 62.5%(15/24). It was followed by supracondylar humeral fracture (20.8%, 5/24) occurring when brachial arteries were injured by fracture end or Kirschner needle. The major treatment (75.0%, 18/24) was resection of pseudoaneurysm with vascular reconstruction. The prognosis was excellent. No case of distal limb necrosis was reported in the literature.Conclusions:Pseudoaneurysms of brachial artery are rare and are mostly caused by blood sampling by vascular puncture of elbow in infants. Local compression or intratumoral thrombin injection may be attempted for smaller pseudoaneurysms. If ineffective, pseudoaneurysm should be removed and brachial artery reconstructed.
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