内脏动脉瘤54例诊疗经验

Diagnosis and treatment of visceral artery aneeeurysm:report of 54 cases

目的探讨内脏动脉瘤的诊断和治疗方法。方法回顾性总结我院1967～1997年收治的54例内脏动脉瘤诊治情况。结果本组内脏动脉瘤54例包括肝动脉瘤13例,胃胰十二指肠动脉瘤13例,脾动脉瘤13例,肾动脉瘤5例,肠系膜上、下动脉瘤分别为3例和1例,腹腔干动脉瘤3例,网膜动脉瘤3例。本组自发性破裂大出血28例,其中破裂入胆管14例,上消化道10例,腹腔及腹膜后4例。术前 CT 证实4例,内脏动脉造影确诊37例,经 MRA 确诊2例。手术治疗43例,死亡9例,围手术期病死率为21%。动脉栓塞治疗6例。结论内脏动脉瘤术前临床诊断极为困难,选择性内脏动脉造影(包括数字减影血管造影术)最具诊断价值,一旦确诊应尽早手术治疗。

Objective To evaluate the diagnosis and treatment of visceral artery aneurysms.Methods We reviewed clini- cal data of 54 patients who were treated for visceral artery aneurysms at our hospital during the past 30 years.Result 54 cases of visceral artery aneurysms involved the hepatic artery in 13 patients,the gastroduodenal-pancreatic arteries in 13,the splenic artery in 13 patients,renal artery in 5,the mesenteric artery in 4,the celiac artery in 3 and gastroepi- ploic artery in 3.Rupture occurred in 28 patients.The aneurysms ruptured into the biliary tract in 14 patients,into the upper gastrointestinal tract in 10,and into the abdominal cavity in 4.Correct preoperative diagnosis was made by CT in 4 cases,by selective visceral arteriography in 37 cases,by MRA in 2 cases.43 patients underwent laparotomy and 9 died with mortality rate of 21%.Six patients were treated by selective embolization of the visceral artery aneurysms. Conclusion Preoperative diagnosis of visceral artery aneurysm is difficult.The most valuable approach is selective visceral arteriography.Surgical therapy is recommended in most patients.