迷走脾动脉瘤12例报道并文献复习

目的 探讨迷走脾动脉瘤的治疗方法及疗效评价.方法 回顾性分析新疆维吾尔自治区人民医院血管外科2012年1月-2014年5月收治的12例迷走脾动脉瘤患者,其中男性4例,女性8例,对其治疗方法进行临床分析.迷走脾动脉瘤均起源于肠系膜上动脉,瘤体均为单发,直径1.5 ～2.8 cm,平均2.1 cm.12例均行手术治疗,4例行开放手术切除瘤体,5例行脾动脉介入栓塞治疗,3例行瘤体内栓塞+肠系膜上动脉内覆膜支架植入.结果 12例治疗均获成功,2例出现腹痛、发热等不适反应.未出现脾动脉瘤复发、增大或破裂.12例均获随访,每隔3个月复查彩色多普勒超声或CT血管成像,随访时间6～24个月,1例术后1年死于腹腔大出血;11例情况良好,无复发.结论 对于具有适合解剖条件的迷走脾动脉瘤,腔内治疗安全有效,对于累及肝动脉的迷走脾动脉瘤,需开放手术进行血管重建.     

创伤性基底动脉动脉瘤1例并文献复习

目的报告1例创伤性基底动脉动脉瘤,总结治疗经验和教训。方法对1例创伤性基底动脉动脉瘤的诊治进行报告,并结合文献对创伤性动脉瘤进行回顾分析。结果创伤性颅内动脉瘤是颅脑损伤的少见并发症,破裂出血可导致灾难性后果。结论创伤性颅内动脉瘤缺乏特有的临床症状,可疑病例可行3D-CTA和DSA检查确诊,开颅手术和血管内治疗是有效的治疗方法。     

肠系膜上动脉瘤破裂1例报告并文献复习

目的：探讨肠系膜上动脉瘤疾病的临床特点,提高对该病的认识。 方法：分析上海市杨浦区中心医院收治的1例肠系膜上动脉瘤自发性破裂患者的临床资料。 结果：该患者以休克表现入院,经腹部增强CT和DSA检查确诊肠系膜上动脉瘤自发性破裂,保守治疗后好转出院。 结论：临床医生应提高对肠系膜上动脉瘤疾病的认识,考虑破裂出血时应及早行CT、DSA造影检查明确出血的来源,以免延误治疗。     

脾动脉瘤破裂致消化道出血1例报告并文献复习

背景与目的:脾动脉瘤破裂致消化道出血的病例在临床极为少见,当其破裂时常表现为间歇性出血,易被漏诊或误诊.笔者对1例脾动脉瘤的临床表现及影像学特点、诊断及治疗措施等方面进行分析总结,以期提高对该病的诊治水平.方法:对1例脾动脉瘤的临床表现、影像学特点、诊疗过程及预后进行回顾性分析,并结合国内外文献,总结脾动脉瘤的临床和影...     

肠系膜上动脉瘤破裂出血1例及文献复习

肠系膜上动脉瘤(superior mesenteric artery aneurysms,SMAAs)是极少见但破裂风险较大的内脏动脉瘤,约占内脏动脉瘤的5.5%[1]。2012年1月我科收治l例肠系膜上动脉瘤破裂患者,成功行256排3D-CTA、腹腔动脉造影后确诊并行介入治疗后治愈出院,总结报道如下。1病例介绍患者男,48岁,因上腹部突发疼痛伴恶心呕吐20 h余入院。体格检查:右侧腹部稍微膨隆,可触     

真性脾动脉瘤结肠瘘行腹腔镜治疗1例报告并文献复习

背景与目的 真性脾动脉瘤结肠瘘是一类罕见且凶险的疾病,笔者报告1例特殊的真性脾动脉瘤结肠瘘患者的诊治过程,以期提高对该病的认识和诊治水平。方法 对1例真性脾动脉瘤结肠瘘患者的临床表现、影像学特点、介入治疗及腹腔镜手术治疗过程及预后进行回顾性分析,并结合国内外文献,总结真性脾动脉瘤结肠瘘的临床和影像学特点、诊断及治疗方法。结果 2020年10月31日北京大学第一医院急诊科收治了1例首发症状为暗红色血便的40岁女性患者,通过腹盆部增强CT、肠镜和脾动脉造影检查发现患者真性脾动脉瘤破裂至结肠脾曲导致下消化道出血,经介入下弹簧圈栓塞治疗后康复出院,出院后无再发便血等不适。2023年8月7日患者排便时从肛门排出金属丝,自行剪断后出现左上腹痛,再次就诊于我院急诊科,通过腹盆部平扫CT发现患者脾动脉瘤栓塞所用的一部分弹簧圈钢丝经脾动脉瘤结肠瘘进入结肠并从肛门脱出,于2023年8月14日行全麻腹腔镜探查+脾切除+脾动脉瘤切除+结肠部分切除+结肠异物取出术,手术过程顺利,术后病理符合真性脾动脉瘤诊断。出院后随访3个月,患者无腹痛便血等不适。真性脾动脉瘤结肠瘘经介入栓塞,腹腔镜手术切除后痊愈,检索国内外近30年文献未见报道。结论 真性脾动脉瘤结肠瘘尽早行增强CT或数字减影血管造影可明确诊断,对于血流动力学稳定患者首选腹腔镜手术切除,血流动力学不稳定患者可先介入弹簧圈栓塞动脉瘤,待血流动力学稳定后再评估腹腔镜手术,能获得较好的预后。     

肺栓塞致肺动脉瘤支气管瘘1例

肺栓塞致肺动脉瘤支气管瘘１例陈秀，王炜华，刘和生，张宪病人男，２１岁。１岁半和６岁时两次行右下肢先天性马蹄内翻足矫正手术。１９９１年１２月无明显诱因高热、胸闷。超声心动图发现右心房内－３ｃｍ×３ｃｍ高回声团块，随心动周期活动（图１、２）。经每日１次青...     

腹腔镜手术治疗肾动脉瘤1例报告并文献复习

目的:探讨腹腔镜术治疗肾动脉瘤的可行性与方法。方法:报告1例59岁女性患者,因"反复高血压10年,检查发现肾动脉瘤1周"入院。CTA示右肾动脉瘤,直径2cm,肾动脉主干发出两支二级动脉分支,动脉瘤位于其中一根二级分支近主干处。患者左侧卧位,建立气腹,游离肾脏及血管,分离动脉瘤体,用哈叭狗钳分别阻断主干及两根二级分支,用剪刀将动脉瘤完整切除。4-0血管缝线缝合动脉破口,2-0可吸收线缝合肾周筋膜,局部放置一引流管。结果:手术成功,手术时间125min,其中热缺血时间28min,血管缝合时间8min,术中出血50ml,患者术后24小时开始进食半流质,48小时开始下床行走。术后3天起患者血压较术前入院时170/100mmhg明显下降,波动于124～145/70～85mmhg。术后7天CT复查示右肾动脉未见狭窄,右肾小部分缺血表现,出院。结论:腹腔镜下肾动脉瘤切除手术可行,熟练的操作与精细的缝合是其关键。     

肾错构瘤1例报告并文献复习

目的:探讨肾错构瘤的治疗方法及疗效,提高对肾错构瘤治疗的认识。方法:对1例肾错构瘤患者先行经导管动脉栓塞术(TAE),然后行不阻断肾蒂的后腹腔镜保留肾单位术(LNSS)。结果:术中出血少。术后病理检查诊断为肾错构瘤。随访3个月未见复发,肾功能正常。结论:对于单发、体积较大的肾错构瘤可行TAE术加LNSS术,术中可不阻断肾蒂,效果满意。     

脾动脉瘤自发性破裂二例并文献复习

目的通过病例回顾及文献复习,提高对脾动脉瘤自发性破裂出血的诊断水平以及了解脾动脉瘤的治疗进展。方法分析中国医科大学附属盛京医院2014年1月及2017年7月2例脾动脉瘤自发性破裂出血病人的临床资料,并复习相关文献。结果 2例均表现为突发腹痛,增强CT可提供良好的术前影像学诊断,需迅速予以外科干预从而降低病人死亡率。结论对于确诊或疑诊病人尽早予以外科干预是脾动脉瘤自发性破裂出血抢救成功的关键。对于脾动脉瘤的治疗,外科手术是金标准,但介入技术的快速发展同样能取得较好的治疗效果,且正在不断突破以往的限制,应用指征越来越广。     

肾动脉瘤介入治疗的方法及疗效

目的 探讨肾动脉瘤(renal artery aneurysm,RAA)腔内介入治疗的方法及疗效.方法 回顾性分析2009年1月至2014年4月17例确诊为RAA并行介入治疗患者的临床资料.男7例,女10例.年龄20 ～ 67岁,平均(46.4±10.3)岁.体检发现5例,表现为腹痛和腰痛各4例,表现为间断性肉眼血尿2例,表现为乳糜尿和少尿各1例.多发9例,单发8例.17例共31个动脉瘤,其中真性动脉瘤26个,假性动脉瘤5个;囊状动脉瘤17个,纺锤形或梭形、不规则形、实质内动脉瘤各4个,夹层动脉瘤2个.8个动脉瘤位于肾动脉主干,19个位于肾动脉二级、三级分支,4个位于肾实质内.6例行瘤腔栓塞+载瘤动脉栓塞术,4例行瘤腔栓塞术,3例行载瘤动脉栓塞术,2例行裸支架辅助瘤腔栓塞术,1例行覆膜支架置入术,1例双侧RAA行右侧裸支架辅助瘤腔栓塞术+左侧瘤腔栓塞术. 结果 本组17例中16例一次手术成功.随访3～53个月,平均23个月,无严重并发症或死亡病例.术后1周3例尿潜血阳性者转为阴性.术后1个月12例的肉眼血尿、腹痛、腰背痛、发热等首发症状消失或明显减轻.术后3～12个月,实验室检查示SCr、BUN、尿常规等未见明显异常.复查超声或CT动脉造影示16例支架及弹簧圈无移位,8例载瘤动脉通畅,未见动脉瘤复发或瘤腔扩大.结论 RAA的腔内介入治疗创伤小、安全、有效.应根据RAA的具体情况制定手术方案.     

支气管动脉栓塞术治疗大咯血的疗效分析

大咯血死亡率极高,达60％～80％,内科保守治疗或外科手术治疗效果极差。支气管动脉栓塞（bronchial artery embolization,BAE）治疗大咯血,微创、安全性高,已成为治疗大咯血的首选方法Ⅲ。本文回顾性分析采用BAE治疗大咯血的患者29例,现报告如下。     

巨大肾动脉瘤血管腔内治疗1例

正患者女,27岁,孕6周,因"妊娠1个月发现右侧腹部搏动性包块"入院。体格检查:血压132/66mmHg,右中腹部触及搏动性包块,右肾动脉听诊区未闻及杂音。实验室检查无异常发现。腹部增强CT:右肾动脉一级分支处可见巨大瘤样扩张,动脉期呈高强化,凸向肾实质外,大小约8.4cm×6.1cm(图1A)。CT诊断:右肾动脉动脉瘤(renal artery aneurysm,RAA)。患者行肾动脉造影:右肾上极可见巨大瘤样扩张,其内血流呈湍流,动脉瘤开口位于右肾动脉主干前段动脉分支,该动脉明显增粗与肾动脉主干相仿(图1B),术中以锥形束CT扫描证实RAA位置及供血动脉。造影后患者行动脉瘤腔内栓塞     

Giant pericallosal artery aneurysm: case report and review of the literature

Pericallosal artery aneurysms comprise 5% of all intracranial saccular aneurysms and are usually small. Giant cerebral aneurysms mostly occur in major arteries. To date, 12 cases of giant pericallosal artery aneurysm have been reported in the literature. An unusual giant thrombosed pericallosal artery aneurysm is reported here. A 65-year-old female presented with headache and personality changes. Computed tomography, magnetic resonance imaging, and cerebral angiography revealed a right-sided giant thrombosed pericallosal artery aneurysm. The patient was operated via an anterior interhemispheric approach and the neck of the aneurysm was successfully clipped. The postoperative period was uneventful. This rare lesion is one of few cases presented in the literature in which neuroradiologic and neuropathologic evaluation was completely performed and the neck of the aneurysm was clipped. Received: 14 November 2000 / Accepted: 4 January 2000     

Traumatic middle cerebral artery aneurysm: case report and review of the literature

Traumatic intracranial aneurysms are rare. A case of traumatic middle cerebral artery aneurysm was presented. A 66-year-old man sustained a severe head injury in a bicycle accident. Serial computed tomography and angiography showed the delayed intracerebral hemorrhage caused by the traumatic middle cerebral artery aneurysm. The aneurysm was trapped and removed. Histological examination clearly revealed the pseudoaneurysm. Traumatic middle cerebral aneurysms were reviewed.     

Giant aneurysm of the azygos pericallosal artery: case report and review of the literature

BACKGROUND: Pericallosal aneurysms are encountered less than 6.7%, and giant aneurysms among them even less. Giant azygos pericallosal artery aneurysm at the callosomarginal bifurcation is extremely rare, and our case presented herein is the second one. The case is discussed with thorough review of the literature. METHODS: A 65-year-old woman presented with an extremely rare giant aneurysm on the azygos pericallosal artery manifesting as subarachnoid hemorrhage in World Federation of Neurosurgical Societies Grade 3. Computed tomography (CT), magnetic resonance angiography (MRA), and four vessel angiography revealed a giant azygos pericallosal artery aneurysm associated with a second aneurysm at the left M1. RESULTS: After recovery to Grade 2, she underwent surgery via the right frontal interhemispheric approach for the azygos artery aneurysm on the 17th day after bleeding. The true dimensions of the aneurysm were greater than indicated by angiography because of partial thrombosis. Trilobulate aneurysm was carefully dissected from the surrounding structures. Postoperative cerebral angiography showed no filling of the clipped aneurysm and preservation of circulation. CONCLUSIONS: The treatment of distal anterior cerebral artery aneurysms is often difficult, because of their broad-based irregular configurations and adherence to surrounding tissue, tendency to bleed irrespective of size and the coexistence of other cerebral aneurysms. However, excellent outcomes can be obtained based on thorough preoperative radiologic evaluation, including magnetic resonance imaging (MRI), and correct selection of surgical approach.     

经导管支气管动脉栓塞术治疗咯血术后复发的原因及预防

目的探讨咯血患者经导管支气管动脉栓塞术(BAE)治疗后出血复发的原因及预防措施。方法对85例咯血患者行选择性或超选择性BAE治疗,以明胶海绵(GS)颗粒和(或)GS条栓塞37例,PVA微粒联合GS(PVA+GS)条多重栓塞48例。所有病例随访6～18个月,对复发病例复查造影明确原因后进行第二次栓塞。结果咯血复发17例,复发率20.00%。其中GS栓塞复发13例,复发率35.14%(13/37),原因为栓塞血管再通(8例),肺内病变供血血管漏栓(2例),肺外体循环动脉供血漏栓(1例)和病变侧支循环形成(2例);PVA+GS栓塞复发4例,复发率8.33%(4/48),原因包括基础疾病进展新生血管形成(3例)和病变侧支循环形成(1例)。结论咯血患者BAE治疗后复发出血与栓塞剂的选择、栓塞技术及基础疾病有关。采用多重栓塞技术、合理选择栓塞剂及积极治疗基础疾病能有效降低咯血复发率。     

肾动脉瘤的血管腔内治疗

目的评价血管腔内治疗对于肾动脉瘤（RAA）的安全性及疗效。方法回顾性分析11例接受血管腔内治疗的RAA患者,治疗方法包括单纯以弹簧圈填塞动脉瘤腔（6例）、载瘤动脉栓塞术（3例）和覆膜支架隔绝术（2例）,并随访3～68个月。结果11例患者共发现13个RAA（右肾9个,左肾4个）,均为真性囊状动脉瘤,对其中11例（11个RAA）行血管腔内治疗。术后5例出现栓塞后综合征,其中4例发生部分肾梗死,肾功能无异常;未见其他严重并发症。随访未见动脉瘤内残腔及内瘘,未见动脉瘤破裂及复发。结论血管腔内治疗RAA安全、有效,成功率高。     

Large neonatal thoracoabdominal aneurysm: case report and review of the literature

We present a neonate with a large saccular aneurysm of the thoracoabdominal aorta, extending from the intrathoracic aorta to the left common iliac artery. No underlying cause could be identified. Despite an early diagnosis, the aneurysm was deemed inoperable because of the lengthy involvement and the frail aspect of all visceral arteries. A review of the literature on congenital abdominal aortic aneurysm in infants was conducted. Eleven cases of live-born infants with a congenital abdominal aortic aneurysm have previously been published. None of them involved as large a part of the thoracic and abdominal aorta as the case presented here.