脾动脉瘤12例治疗方式选择及疗效分析

Treatment of splenic artery aneurysm: report of 12 cases

目的探讨脾动脉瘤治疗的方法及疗效。方法回顾性分析2014年4月至2016年7月郑州大学第一附属医院收治的12例脾动脉瘤病人的临床资料。所有病人术前经超声、增强CT或者CTA明确诊断,评估脾动脉瘤的大小、性状,脾动脉载瘤动脉的直径,动脉瘤所处脾动脉的位置、形状及瘤颈大小。根据病人术前影像学检查结果选择治疗方法。病人出院后均获得随访,时间为3个月至3年,影像学复查超声或者腹部CT。结果 12例病人中,11例拟行介入治疗。其中1例因造影后发现瘤体巨大,距离腹腔干开口过近,且有肠系膜上动脉等血管分支供血,而放弃介入办法,转为外科手术治疗,其余10例均实施介入治疗;另1例具有外科手术指征,选择直接外科手术治疗。所有病人术后随访情况:期间无死亡病例,无脾脏严重梗死、动脉瘤复发等并发症。结论介入治疗是脾动脉瘤首选的安全、微创且有效的治疗手段,而外科手术治疗仍然是部分脾动脉瘤的最佳治疗方法。

Objective To investigate the method and effect of splenic artery aneurysm treatment. Methods The clinical data of 12 patients with splenic artery aneurysms treated in the First Affiliated Hospital of Zhengzhou University from Apr.2014 to Jul.2016 were retrospectively analyzed. All patients were diagnosed by ultrasound, enhanced CT or CTA before surgery, The size and character of the splenic artery aneurysm, the diameter of the splenic artery, the position and shape of the splenic artery and the size of the aneurysm neck were evaluated. The treatment was selected according to the preoperative imaging findings. All patients were followed up for 3 months to 3 years, and the imaging was reviewed for ultrasound or abdominal CT. Results Of the 12 patients, 11 were prepared for interventional treatment. One case of the tumor was found to be huge, close to the opening of the celiac axis, and had blood vessels from the superior mesenteric artery. So we gave up the interventional treatment and switched to surgical treatment. The other 10 cases were treated with interventional therapy.？ The other 1 cases had surgical indications and selected direct surgical treatment. All of the operations were successful. All patients were followed up, during which no death or other severe complications occurs. Conclusion Interventional therapy is the first choice for splenic artery aneurysm. It has the characteristics of safety, minimally invasive and effective. But surgical treatment is still the best treatment for some splenic artery aneurysm.