脾动脉瘤7例诊治分析

Diagnosis and treatment of 7 cases of splenic aneurysm

目的探讨脾动脉瘤的诊断和手术治疗方法。方法回顾性分析7例脾动脉瘤患者的临床资料。结果6例经彩色多普勒超声(B超)初步诊断;4例经CT动脉造影(CTA),2例经数字减影血管造影术(DSA),1例经磁共振造影(MRA)确诊;无1例依靠临床症状而确诊。单纯脾动脉瘤切除术1例,脾动脉瘤加脾脏切除术1例,脾动脉瘤切除加动脉重建术1例,动脉瘤近远端脾动脉结扎术1例,脾动脉瘤栓塞术2例,脾动脉瘤栓塞术加脾切除术1例。随访2个月至3年。无死亡及严重并发症病例。结论脾动脉瘤依赖临床表现难以诊断,B超有筛选价值,CTA,MRA,DSA均有诊断价值。一旦确诊应尽早选择腔内介入栓塞治疗或手术方法。

Objective To investigate the methods of diagnosis and treatment of splenic aneurysms （SA）. Methods Clinical data of 7 SA cases was retrospectively analyzed. Results Preoperatively, preliminary diagnosis was made based on type-B ultrasonic scanning in 6 cases, diagnosis was confirmed by CT angiogrophy （CTA） in 4 cases, by digital substraction angiography （DSA） in 2 patients and magnetic resonance angiography （ MRA ） in 1 case, but no case was confirmed solely by clinical symptoms. Of the 7 cases, 1 underwent splenic aneurysm resection, 1 combined resection of splenic aneurysm and spleen, 1 had resection of splenic aneurysm and reconstruction of splenic artery, 1 ligation of proximal and distal splenic arteries, 2 endovascular embolization, and 1 endovascular embolization and resection of spleen. All patients were followed up for 2 months to 3 years, but no mortality or serious complications were found. Conclusions It is difficult to diagnose splenic aneurysm based solely on clinical symptoms, but CTA, MRA and DSA are importtant for diagnosis. B-mode uhrasond is of help for screening. Endovascular embolization or surgical procedure should be employed once the diagnosis is confirmed.