内脏动脉瘤手术治疗临床分析

Surgical treatment of visceral artery aneurysms

目的总结内脏动脉瘤（VAAs）的诊断与治疗经验。方法2003年6月至2008年12月共收治8例VAAs；男性2例，女性6例；年龄30—72岁，平均49岁。8例患者共有9个动脉瘤，包括脾动脉瘤4例，肠系膜上动脉瘤2例，肾动脉瘤2例（3个）。均经彩色超声、CTA或DSA明确诊断。6例行经腹动脉瘤切除，其中3例行血管重建。1例伴门静脉高压患者，行脾动脉瘤切除、脾切除和脾肾静脉分流术。1例双侧肾动脉瘤患者，左肾动脉瘤较大，且接近肾门，行动脉瘤切除和肾摘除术，右肾动脉瘤直径1．2cm，密切随访。2例经股动脉行动脉瘤栓塞治疗。结果本组8例VAAs患者，无论是动脉瘤切除、两端动脉结扎；还是端端吻合，人工血管间置血流重建；以及经股动脉病灶栓塞治疗，多取得了满意的效果。没有死亡和严重并发症发生。随访2—60个月，平均26．5个月，效果良好。结论VAAs一旦明确诊断，应积极采取治疗措施。选择性手术或栓塞术是安全和有效的治疗方法。直径〈2cm且无症状的VAAs可考虑密切随访。

Objective To analyze the experience with diagnosis and surgical treatment of visceral artery aneuryams （VAAs）. Methods From June 2003 to December 2008, 8 patients （2 male and 6 female） with 9 VAAs underwent surgical treatment. Mean age was 49 years （ranged from 30 to 72 years）. The site of aneurysmal disease was splenic artery in 4 cases, superior mesenteric artery in 2 cases, renal artery in 2 cases （3 aneurysms）. In 1 patient of splenic artery aneurysm, portal vein hypertension coexisted. All the VAAs of preoperative diagnostic workup consisted of a ultrasound, computed tomography （CT） scan, and digital subtraction angiography. Six patients were operated on and two patients was treated with endovascular procedures. Only one small VAAs was treated with follow-up. Results No deaths or major complications occurred in the perioperative period. All the patients remained symptom free during a follow-up of 26. 5 months （ranged from 2 to 60 months ）. Follow-up consisted of clinical and ultrasound scan examinations or CT scan at 1 and 6 months, and yearly thereafter. Conclusions Aggressive approach to the treatment of VAAs is essential. Elective open surgical treatment and an endovascular procedure of visceral artery aneurysms are both safe and effective, and offers satisfactory early and long term results. There is some evidence that small （ 〈 2 cm） and asympotmatic VAAs may be safely observed.