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題 名 | Hypoplastic Aortoiliac Syndrome in the Arseniasis Area (Southwestern Coast) of Taiwan=臺灣西南沿海慢性砷中毒地區的發育不良性腹主動脈髂動脈症候群 |
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作 者 | 許文憲; 李清龍; 陳勁辰; | 書刊名 | 臺灣外科醫學會雜誌 |
卷 期 | 40:6 2007.11-12[民96.11-12] |
頁 次 | 頁243-248 |
分類號 | 416.263 |
關鍵詞 | 砷中毒; 周邊血管疾病; 腹主動脈髂動脈發育不良; Hypoplastic aortoiliac syndrome; HAIS; Arseniasis area of Taiwan; Intermittent claudication; Area ratio; Lumbar sympathectomy; Aortofemoral bypass; Profundaplasty; |
語 文 | 英文(English) |
中文摘要 | 在台灣西南沿海慢性砷中毒地區,我們追蹤了288位患有周邊血管疾病的個案,91位病人曾有核磁共振或動脈攝影等檢查資料,其中8位顯示有「發育不良性腹主動脈骼動脈症候群(Hypoplastic aortoiliac syndrome, HAIS)」,而女性佔5位。我們計算病人左右髂動脈截面積總和與主動脈分盆處截面積之比值,發現其值爲0.39~0.7,正常值爲0.78~1.2。此症候群的臨床表現是臀部與大腿的間歇性跛行及下肢的嚴重缺血。採用的外科治療方式以交感神經切除及血管重建手術爲主,其中4位接受腹主動脈-股動脈繞道合併腰交感神經切除手術,1位施行骼動脈-股動脈繞道合併腰交感神經切除手術,2位接受腰交感神經切除合併股深動脈整型手術,另有1位進行單側胸交感神經切除以治療指頭缺血性壞死及疼痛。術後7位病患保全下肢,一位病患接受膝下截肢,另有2例接受腳趾切除。目前HAIS的原因不明,是非特異性的動脈血管炎(高安氏症)或是先天性的腹主動脈髂,動脈發育不良症,尚待進一步的研究。 |
英文摘要 | Objective: The hypoplastic aortoiliac syndrome (HAIS) has been well documented in the literature and it is unusually found in the population of atheroslerosis with aortoiliac occlusive disease. In the arseniasis area, so-called Blackfoot Disease (BFD) endemic area in the southwestern coast of Taiwan, we encountered HAIS patients in whom the patho-etiology was not been clear, but the surgical revascularization for limb salvage was feasible. Methods: From Jan. 2001 through Jan. 2007, 8 cases of HAIS were recognized among 288 patients in the BFD endemic area. The image study showed hypoplasia of the infrarenal aorta and iliofemoral system with mild to moderate degree of atherosclerotic change in the distal runoff. Clinically, all patients presented with severe intermittent hip or thigh claudication associated with ischemic changes of the foot or toes. The area ratio of the sum of cross-sectional areas of common iliac arteries/cross-sectional area of aorta above the bifurcation ranged between 0.39 and 0.7 (normal range 0.78 to 1.2). Results: Of the 8 HAIS patients, 1 patient underwent an aorto-bifemoral bypass with lumbar sympathectomy (LS), 2 received an aorto-unifemoral bypasses with LS, 1 had an iliofemoral bypass with LS, 3 had profundaplasty with LS, and the remaining one had a unilateral thoracic sympathectomy for finger ischemia and constant poikilothermia of both hands, but declined vascular reconstruction. There was no operative or perioperative mortality. The operative complications included minor wound infection, wound hematoma, paralytic ileus, and atelectasis. The preexistent pregangrenous toes needed amputation in the post-operative days when demarcation became clear. Conclusions: The hypoplastic aortoiliac syndrome (HAIS) associated with ischemia of toes should be treated as aortoiliac occlusive disease without delay. We believe the bypass grafting through a retroperitoneal approach with adjunct lumbar sympathectomy is the treatment of choice if patients' general condition permits. |
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