肝炎后肝硬化性脾动脉瘤的CT表现与手术方式选择的相关研究

Correlative research of CT manifestation of splenic artery aneurysm associated with posthepatitic cirrhosis and operation approach

目的：探讨肝炎后肝硬化性脾动脉瘤的CT征象与手术方式选择的关系。方法回顾性分析61例肝硬化门脉高压性脾动脉瘤的CT表现（部位、数量、大小、门静脉改变、曲张静脉团、门体分流血管网和脾脏改变）、临床特征和手术方式，并进行统计。结果4例主瘤体位于脾动脉远端、直径1.0~2.0 cm、存在脾肾分流和脾大的患者行主瘤体旷置术＋分支小动脉瘤分期栓塞。瘤体切除＋脾脏切除＋曲张血管团离断术15例中，主瘤体位于脾动脉中段4例和脾动脉远端11例，主瘤体直径大于2.0cm的15例和1.0~2.0 cm的13例，门静脉海绵样变4例、脾胃静脉曲张5例，食管胃底静脉曲张15例，脾胃肾静脉分流4例，巨脾15例和脾梗死4例。瘤体切除＋分支小动脉瘤分期栓塞7例，主瘤体位于脾动脉近段7例，主瘤体直径1.0~2.0 cm 7例，食管胃底静脉曲张2例，脾大7例。4例单发、瘤体直径1.0~2.0 cm、脾大患者行瘤体切除＋重建脾动脉连续性，其中脾动脉近端1例、中段2例和远端1例。结论可根据脾动脉瘤的部位、数量、大小、门静脉改变、曲张静脉团、门体分流血管网和脾脏改变结合患者年龄、性别、体重指数及病史选择手术方法。

Objective To evaluate how to select operation procedures for different CT manifestation of splenic artery aneurysm （ SAA） with posthepatitic cirrhosis. Methods In 61 cases with SAA,the CT manifestation （ location,number,size,portal vein,varicose vein,proxi-mal splenorenal shunt and spleen changes） of SAA,clinical features of cases,and operation approach were were retrospectively analyzed. Re-sults 4 patients who have the primary tumors located in the distal splenic artery with diameter 1. 0~2. 0 cm,spleen kidney shunt and mega-losplenia were given aortic aneurysm exclusion and branch aneurysms embolism by stages. Amiong the 15 cases of tumors resection,splenecto-my and devascularization,there were 4 cases of the primary tumors located in the middle of splenic artery and 11 cases in the distal splenic artery. There were 15 cases whose diameter of the primary tumor were lager than 2. 0 cm and 13 cases whose diameter of the primary tumor were 1. 0~2. 0 cm. There were 4 cases of cavernous transformation of portal vein,5 cases of splenic and gastric varices,15 cases of esophage-al and gastric varices,4 cases of splenic and gastric venous shunt,15 cases of megalosplenia and 4 cases of splenic infarction. Tumors resec-tion and branch aneurysms embolism by stages were conducted in 7 cases. The primary tumors located in the proximal splenic artery occured in 7cases,and the diameter of the primary tumor were 1. 0~2. 0 cm occured in 7 cases. Esophageal and gastric varices occured in 2 cases and splenomegaly occured in 7 cases. And there were 4 cases whose diameter of the tumor were 1. 0~2. 0 cm were given tumor resection and re-construction of splenic artery and continuity, including 1 case of proximal splenic artery,2 cases of medial splenic artery and 1 case of distal splenic artery. Conclusion Operation procedures were confirmed by CT findings such as location,number,size,portal vein,varicose vein, proximal splenorenal shunt and spleen changes of SAA combined with age,gender,body mass index and history.