脾动脉头端动脉瘤的外科治疗11例报告

Surgical treatment of 11 patients with aneurysm at the head of splenic artery

目的探讨脾动脉头端真性动脉瘤的切除方法以及血管重建方法,总结临床治疗经验。方法回顾性总结2000年1月—2013年6月作者收治的11例资料,均经彩色超声、CT和血管造影检查证实脾动脉头端真性动脉瘤。肝动脉脾脏动脉远端自体静脉移植1例;肾下主动脉—脾动脉人工血管转流7例;动脉瘤、脾脏切除2例,多发动脉瘤切除、脾动脉结扎、脾切除1例。结果手术后10~14天治愈出院,随访1~14年,9例存活,2例死亡,其中1例主脾转流后2年死于急性心肌梗死,1例动脉瘤切除、脾切除后5年死于急性脑出血。7例主脾转流中,1例术后2年吻合口逐渐狭窄,术后6年完全闭塞,但一直无脾脏梗死,脾脏供血由胃短血管及其侧枝提供;余6例主脾转流和1例自体血管移植者未见吻合口狭窄或假性动脉瘤。结论脾动脉头端真性动脉瘤切除、脾动脉血管重建是一种较好的治疗方案。

Objective To investigate the resection methods of true aneurysm at the head of splenic artery and reconstruction method of blood vessels and to summarize the clinical treatment experience. Methods The clinical material of 11 patients with the true aneurysm from January 2000 to June 2013 at the head of splenic artery was retrospectively analyzed. All patients were definitely diagnosed by color ultrasonography,computer tomography（ CT） and angiography as true aneurysm at the head of splenic artery,among which there was one case with distal autologous vein transplantation of the hepatic and splenic artery,seven cases with artificial blood vessel bypass between the infrarenal aorta and the splenic artery,2 cases with the splenectomy and aneurysm resection,and one case with splenectomy combined with multiple aneurysm resection,splenic artery ligations and splenectomy.Results All cases were cured and discharged from the hospital after 10 days to 14 days of operation.During 1 year to 14 years follow- up,9 cases survived and 2 cases died. In these patients,1 case with aorta splenic artery bypass operation died of acute myocardial infarction after 2 years and 1 case with post aneurysm resection and the splenectomy operation died of acute cerebral hemorrhage after 5years. Among 7 cases with aorta splenic artery bypass,anatomosis of 1 case gradually became narrow after 2 years and completely occluded after 6 years of operation,but no splenic infarction was found and the spleen blood was supplied by the short gastric vessel and its collaterals. The other 6 cases with aorta splenic artery bypass and 1 case with autologous vascular transplantation had no stenosis or pseudoaneurysm in the stoma. Conclusion The aneurysmectomy and vascular reconstruction of splenic artery is a better therapy for patients with aneurysm at the capitular head of the splenic artery.