脾动脉瘤个体化治疗方式选择及疗效分析的单中心经验

Single-center experience in the selection and efficacy analysis of individualized treatment for splenic artery aneurysms

目的评价以血管腔内弹簧圈栓塞技术为主的不同方式治疗脾动脉瘤(SAA)的安全性及近中期疗效。方法本研究为回顾性队列研究。回顾性分析2018年12月至2022年8月江苏大学医学院附属昆山医院血管外科收治的46例SAA患者的临床资料,其中采用血管腔内弹簧圈栓塞为主的介入治疗29例,急诊开放手术2例,定期随访15例,观察患者围术期并发症及随访结果,评估三种处理方式的安全性及临床疗效。结果手术治疗31例患者均获成功。其中29例行腔内SAA弹簧圈栓塞术,手术时间为(48.3±12.6)min,住院时间为(2.3±0.8)d,治疗费用为(6.3±1.1)万元;术后3例出现左季肋部隐痛,1例有低热表现。2例为SAA破裂,急诊行SAA+脾脏切除术,中位手术时间为67.0(54.5,79.5)min,住院时间为7.5(7.3,7.8)d,治疗费用为3.5(3.4,3.5)万元;无术后出血、感染、胰瘘或胰腺炎等严重并发症。随访(13.5±8.0)个月,腔内治疗患者有2例出现小面积脾梗死,其余患者术后无异位栓塞、大面积脾梗死、感染等严重并发症;保守治疗患者15例,复查瘤体均无明显增大。结论SAA患者应根据病变解剖位置、大小及进展等进行个体化分析,有手术指征者采用弹簧圈栓塞治疗安全有效,创伤小、并发症少、住院时间短,但费用相对较高。急诊破裂SAA外科手术治疗相对可靠,而无外科干预指征者则可以考虑动态随访。

Objective To evaluate the safety and early-to mid-term efficacy of different modalities for treating splenic artery aneurysm(SAA)mainly by endovascular spring coil embolization technique.MethodsThis study was a retrospective cohort study.The clinical data of 46 patients with SAA admitted to Department of Vascular Surgery,Kunshan Hospital Affiliated to Jiangsu University School of Medicine from December 2018 to August 2022 were retrospectively analyzed,of which 29 cases were treated with interventional therapy,mainly using endovascular spring coil embolization,2 cases with emergency open surgery,and 15 cases with regular follow-up.The perioperative complications of the patients and the results of the follow-ups were observed,and the safety and clinical efficacy of the three treatment modalities were evaluated.ResultsSurgical treatment was successful in 31 patients.Among them,29 cases underwent spring-coil embolization,with a operation time of(48.3±12.6)min,hospitalization time of(2.3±0.8)d,and treatment cost of(63±11)thousand yuan.Postoperatively,3 patients developed vague pain in the left quarter rib,and 1 patient showed low fever.Two cases with SAA rupture underwent SAA+splenectomy in the emergency,with a median operation time of 67.0(54.5,79.5)min,hospitalization time of 7.5(7.3,7.8)days,and treatment cost of 35(34,35)thousand yuan.No postoperative serious complications such as hemorrhage,infection,pancreatic fistula,and pancreatitis.At the follow-up of(13.5±8.0)months,2 patients with endovascular treatment developed small splenic infarction,and the rest of the patients had no severe complications such as heterotopic embolism,large splenic infarction and infection,and 15 patients with conservative treatment had no noticeable enlargement of the tumor in the review.ConclusionPatients with SAA should be examined individually according to the anatomical location,size,and progression of the lesion,and those with surgical indications should be treated with spring coil embolization,which is safe and effective,with less trauma,fewer complications,and shorter hospital stay,but with relatively high cost.Surgical treatment of emergent ruptured SAA is relatively reliable,while dynamic follow-up may be considered for those without indication for surgical intervention.