内脏动脉瘤的外科治疗

Surgical management of splanchnic artery aneurysms

目的总结腔内技术和外科手段治疗内脏动脉瘤的疗效。方法回顾性分析10例内脏动脉瘤患者的临床资料。男4例，女6例，年龄28—74岁，平均（56±13）岁。其中脾动脉真性动脉瘤5例，脾动脉假性动脉瘤1例，肠系膜上动脉瘤2例，腹腔干结核性假性动脉瘤1例，肾动脉瘤1例。结果1例腹腔干假性动脉瘤行支架型人工血管腔内修复术，1例脾动脉瘤行支架型人工血管腔内修复术失败，改为开腹手术治疗，另外8例直接行开腹手术治疗。手术均获成功，康复出院。术后住院时间7—18d，平均（10±5）d，本组所有患者获随访，随访时间3个月至6年，平均（27±12）个月。无死亡病例，无动脉瘤复发，无胃肠道、肝脏、脾脏、肾脏缺血梗死及其他严重并发症发生。结论内脏动脉瘤开放手术治疗疗效可靠，而腔内治疗则是一种有前途的微创治疗手段。

Objective To analyse the management of splanchnic artery aneurysms by open surgery and endoluminal therapy. Methods The clinical data of 10 splanchnic artery aneurysm patients （four male, six female） hospitalised from January 2002 were analysed retrospectively. The average age was （56 ±13） years （28 -74）. Surgical or endoluminal treatment for six cases of splenic artery aneurysms or pseudoaneurysms were applied, among which multiple splenic artery aneurysms was found in one, and aberrant aneurysms at the proximal section of the splenic artery originating from a spleno-mesenteric trunk was found in three, splenic artery pseudoaneurysm in one and single aneurysm with normal splenic artery in anatomy in one. Besides, there were two superior mesenteric artery aneurysm, one of tuberculous celiac artery pseudoaneurysm and one renal artery aneurysm. Results The tuberculous celiac artery pseudoaneurysm was successfully managed by deploying a stent-graft endoluminally. One case was converted to open surgery after the splenic artery aneurysm was only paitially covered by a stent-graft. The other 8 cases were successfully treated by open surgery. All of the operations are successful. All patients were followed up from three months to six years, during which no death or other severe complications occurs. Conclusions The splanchnie artery varies from one to another anatomically. Preoperative CT scan or digital substraction angiology are helpful for the diagnosis of the splanehnie arterial aneurysms and choosing an appropriate management. Conventional open surgery is effective and reliable, while endoluminal therapy is a minimally invasive alternative.