脾动脉瘤的治疗方法及分析:附23例报告

Diagnostic and therapeutic experiences of 23 cases of splenic artery aneurysms

目的总结脾动脉瘤诊疗相关经验,评估不同治疗方式有效性及安全性。方法回顾性分析从2010年5月—2020年12月在苏州大学附属第二医院血管外科诊治的脾动脉瘤患者,共23例。其中开放手术治疗1例,介入手术治疗16例,保守治疗6例。通过分析患者围手术期及术后随访相关资料,评估3种治疗方式的有效性及安全性。结果共纳入23例患者,其中开放手术治疗的1例患者诊断为脾动脉瘤破裂,瘤体直径为75.84 mm,行脾动脉瘤+脾脏切除术。腔内治疗的16例患者平均瘤体直径为(33.72±26.38)mm,其中12例患者行脾动脉瘤弹簧圈栓塞术,4例患者行支架辅助下脾动脉瘤栓塞术。术后随访显示,手术治疗的患者术后均未发生再通、异位栓塞、破裂出血、大面积脾梗死等并发症。保守治疗患者的瘤体直径在随访期间与确诊时无明显差异。结论直径<3 cm、稳定的、无症状的真性动脉瘤患者,可选择保守治疗,但需要定期随访观察;而直径>3 cm、假性动脉瘤、在育龄妇女中发现的脾动脉瘤、瘤体明显增大或伴有相关临床症状时,应积极治疗,降低瘤体破裂的风险。

Objective To summarize the diagnostic and therapeutic experiences of splenic artery aneurysms(SAAs),and to evaluate the safety and effectiveness of different therapies for SAAs.Methods A total of 23 patients with splenic artery aneurysms were diagnosed and treated in the Second Affiliated Hospital of Soochow University from May 2010 to December 2020.Treatments consisted of open surgery(1 patient),endovascular surgery(16 patients:12 embolizations,4 stent-assisted coiling)and conservative treatment(6 patients).The safety and effectiveness of different therapies were evaluated by analyzing the data of patients.Results One patient with a rupture splenic artery aneurysm was treated by open surgery.Her aneurysm size was 75.84 mm.The mean size of aneurysms in patients receiving endovascular procedure was 33.72 mm±26.38 mm.In patients treated with endovascular procedure,the aneurysm was always excluded,without complications such as recanalization,rupture,coil migration,recanalization and so on.The patients receiving conservative treatment had no follow-up mortality.Conclusion For true splenic artery aneurysms with size<3 cm,remaining stable and asymptomatic,it is safe to choose conservative surveillance.Serial imaging follow-up is required.Treatment for aneurysms with size>3 cm,splenic artery pseudoaneurysms of any size,SAAs of any size in women of childbearing age,and aneurysms with a rapid growth rate and clinical symptoms,curative treatment should be considered.