脾动脉瘤27例诊治分析

Diagnosis and treatment of splenic aneurysm: Analysis of 27 cases

目的 探讨脾动脉瘤的早期诊断和治疗方法。 方法 对 195 7年 9月～ 2 0 0 0年 6月诊治的 2 7例脾动脉瘤作一回顾性分析。 结果 2 7例脾动脉瘤中伴动脉粥样硬化 12例 ,门静脉高压症 9例 ,胰腺炎 2例 ,外伤 2例 ,肌纤维发育不良及细菌性心内膜炎所致各 1例。发生自发性破裂大出血 4例 (14 8% )。术前 2 0例经彩超及彩色多普勒血流显像 (CDFI)检查初步确诊 16例 ;5例经螺旋CT血管造影 (SCTA)、5例经选择性内脏动脉造影、5例经数字减影血管造影 (DSA)、1例经磁共振血管造影三维重建 (3DMRA)而确诊 ;术前依靠临床表现获诊断仅 1例 ;11例经手术探查确诊。本组行包括胰尾脾的脾动脉瘤切除术 11例 ,脾动脉瘤切除加脾动脉重建术 6例 ,脾动脉瘤切除未重建脾动脉 3例 ,动脉瘤近远端脾动脉结扎术 3例 ,介入栓塞术 4例。无死亡病例。 结论 重视和警惕脾动脉瘤的可能并通过CDFI、SCTA、3DMRA及DSA等影象技术对脾动脉瘤作出早期诊断 ;一旦确诊应根据病情选择微创、安全。

ObjectiveTo evaluate the advancement in early diagnosis and treatment of splenic aneurysm (SA). [WT5”HZ]Methods[WT5”BZ] Clinical data on 27 cases of SA treated in our hospital from September 1957 to July 2000 were retrospectively analyzed. [WT5”HZ]Results[WT5”BZ] Of the 27 patients, 12 had atherosclerosis, 9 portal hypertension, 2 pancreatitis and 1 fiber dysplasia and bacterial endocarditis. Meanwhile, spontaneous rupture of the splenic artery occurred in 4 patients. Preoperatively, early diagnosis was made by color duplex flow imaging (CDFI) in 16 patients. For the 16 patients, further diagnoses were achieved by spiral CT angiography (SCTA) in 5, selective visceral arteriography in 5, digital substraction angiography (DSA) in 5 and magnetic resonance angiography (MRA) in 1. The diagnosis was preoperatively confirmed by clinical symptoms in only 1 patient but by operation in 11. Resection of splenic aneurysm, spleen and pancreatic tail was performed in 11 patients, resection of splenic aneurysm and reconstruction of splenic artery in 6, resection of splenic aneurysm alone in 3, ligation of proximal and distal splenic arteries in 3 and endovascular embolization in 4. There was no death among all the patients. [WT5”HZ]Conclusions[WT5”BZ] Diagnosis of SA can be made using CDFI, SCTA, MRA and DSA. As soon as the disease is diagnosed, the less traumatic, safer and more effective endovascular embolization or surgical procedure should be employed to treat the patients.