脾动脉瘤9例诊治经验

Surgical management experience of splenic aneurysm: a study of 9 cases.

目的 总结 9例脾动脉瘤的临床治疗经验。方法 1999年 12月至 2 0 0 3年 3月上海第二医科大学附属仁济医院经多普勒B超、CT、数字减影血管造影术 (DSA)或磁共振成像 (MRI)检查 9例病人术前确诊为脾动脉瘤。手术方法包括动脉瘤体近远端动脉结扎术 2例 ,动脉瘤切除脾动脉重建 2例 ,动脉瘤切除、动脉瘤 门静脉内瘘关闭、脾切除 1例 ,动脉瘤伴胰体尾部切除加脾切除 4例。结果 随访 5个月至 3年所有病人均手术治愈。无死亡及严重并发症。随访期间无动脉瘤复发或上消化道出血 ,腹水消失。结论 脾动脉瘤一般起病隐匿 ,很少有临床症状。选择性内脏动脉造影最具有诊断价值。手术切除是脾动脉瘤最可靠的治疗方法 ,由于动脉瘤有破裂可能 ,有症状的脾动脉瘤是手术治疗的绝对指征。

Objective To summarize the surgical management experience of splenic aneurysm. Methods From December 1999 to March 2003, 9 patients with splenic aneurysms were treated in Shanghai Renji Hospital. All of them were accurately diagnosed by Duplex, DSA, CT or MRI before operations. Two patients were treated through ligation of the proximal and distal neck of the aneurysms. Two cases were treated by aneurysms resected and arterial reconstruction. One case was treated by closure of the portal vein splenic fistula and splenectomy. Four patients were performed resection of pancreatic body and tail plus splenectomy. Results All patients were followed up from 5 month to 3 years and were cured. No mortality and serious complications existed. During the follow-up period, no aneurysms and upper digestive track bleeding recurred. Conclusion Splenic aneurysms anomalously arise and are asymptomatic. Selective visceral artery angiography has the best diagnostic value. Surgical management is the most reliable method. Surgical treatment for splenic aneurysms is indicated in any symptomatic patient because of the tendency to rupture.