脾叶动脉变异及其临床意义

Lobar artery variation of the spleen and its clinical significance

目的探讨脾叶动脉变异及其在介入治疗中的临床意义。方法回顾性随机选择2011年12月至2012年9月江西省宜春市人民医院收治经皮部分性脾动脉栓塞术患者术前、术中、术后造影资料,判断脾叶动脉是否有变异血管分支,对变异动脉分支开口,变异动脉血管大小,变异血管数量作一分析,并总结脾叶动脉发出的胃短动脉、胃网膜左动脉、胰尾动脉变异。结果 43例脾动脉造影中,发现存在脾叶变异动脉15例,其中胃短动脉变异15例,胃网膜左动脉变异3例,胰尾动脉变异1例,分别占34.8%、6.9%和2.3%。22支变异血管中,介入治疗时成功超选变异动脉开口12支,不能超选择越过变异开口动脉10支,所有病例术后DSA均未发现变异动脉闭塞情形,术后无变异血管栓塞并发症。结论脾脏变异动脉较多,尤其是胃短动脉变异发生率较高,在介入治疗中,对变异动脉原则上进行超选,对不能成功超选者,尽量选用颗粒大小超过变异血管管径的颗粒,同时采用缓慢、分次、低压、流控方式进行栓塞,一般都不会出现严重并发症。

Objective To discuss the lobar artery variation of the spleen and its clinical significance in interventional therapy. Methods The angiographic materials, which were obtained before, during and after the partial splenic embolization procedure during the period from Dec. 2011 to Sep. 2012, were collected and analyzed retrospectively. The presence or absence of the lobar artery variation of the spleen was judged. The orifice, size and number of the variant vessel were analyzed, and the variations of the short gastric artery, left gastroepiploic artery and caudal pancreatic artery that originated from splenic lobar artery, were determined. Results Of 43 cases receiving splenic arteriography, splenic lobe artery variation was seen in 15, including the variation of short gastric artery （n = 15,34.8%）, left gastroepiploic artery （n = 3,6.9%） and caudal pancreatic artery （n = 1,2.3%）. Of the 22 variant arteries, successful super-selective eatheteri- zation to pass the orifice of the variant vessel was accomplished in 12, and failure to pass the orifice of the variant vessel in 10. Postoperative DSA showed that no obstruction of the variant artery was found in all cases. After the treatment, no thrombosis complications of the variant vessels occurred. Conclusion The variation of splenic artery is a common finding. The incidence of short gastric artery variation is rather higher. In principle, super-selective catheterization to pass the orifice of the variant artery should be carried out. When super-selective catheterization to pass the orifice of the variant artery fails, the embolic particles larger than the diameter of the variant artery should be employed, and slow injection, fractionated dose injection, lower- pressure injection as well as flow control mode injection should also be employed to accomplish the embolization procedure. In this way, usually no severe complications would occur. （J Intervent Radiol, 2013, 22： 064-067）