紧邻腹腔干脾真性动脉瘤的手术治疗：附7 例报告

目的：探讨紧邻腹腔干脾动脉瘤的治疗方法。 方法：回顾性分析2000年1月—2012年6月收治的7例紧邻腹腔干脾动脉瘤患者临床资料。 结果：7例术前均经彩超、CT及血管造影检查确诊,均在全身麻醉下手术治疗,包括动脉瘤切除、肾下主动脉—脾动脉人工血管转流4例;动脉瘤切除、脾脏切除2例;多发动脉瘤切除、脾动脉结扎、脾切除1例。手术后10~14 d治愈出院,随访2~14年,存活5例,死亡2例,其中1例主-脾转流术后2年死于急性心肌梗死,1例动脉瘤切除+脾切除术后5年死于急性脑出血。存活5例中3例为主-脾动脉转流者（1例术后2年吻合口逐渐狭窄,术后6年完全闭塞,但未见脾脏梗塞,余2例未出现吻合口狭窄或假性动脉瘤）;2例为动脉瘤切除+脾脏切除者。 结论：动脉瘤切除+脾动脉重建是治疗紧邻腹腔干脾真性动脉瘤的有效方法。     

Ruptured gastroepiploic artery aneurysm: A case report

IntroductionGastroepiploic artery aneurysms are extremely rare, with few reported cases in the literature. The risk of rupture however, is high and thus warrants attention.Presentation of caseHere we present a rare case of a women who presented to the emergency department in shock and was found to have a ruptured gastroepiploic artery aneurysm during surgical exploration. Suture ligation of the aneurysm was completed.DiscussionAlthough rare, gastroepiploic artery aneurysms have up to a 90% rate of rupture and therefore require intervention. A laparoscopic approach has been described however, in cases where rupture has occurred, urgent laparotomy and control of hemorrhage is needed.ConclusionWe describe a rare case of a ruptured gastroepiploic aneurysm that was successfully managed with urgent laparotomy and aneurysmal resection.     

胰十二指肠动脉瘤合并腹腔干动脉狭窄的介入治疗：附6例报告

目的:探讨胰十二指肠动脉瘤(PDAA)合并腹腔干动脉狭窄的治疗时机及方式的选择。方法:回顾性分析6例PDAA患者临床资料,其中4例因动脉瘤破裂出血,2例未出血被偶然发现,6例均合并腹腔干动脉狭窄或闭塞,所有患者行腔内动脉瘤栓塞治疗。结果:6例患者中,男5例,女1例;年龄42～81岁,平均59.8岁;瘤径8～21 mm,平均14.6 mm;2例为真性动脉瘤,4例为假性动脉瘤;4例位于胰十二指肠下后动脉,2例位于胰十二指肠下前动脉;5例患者有腹腔干动脉狭窄,狭窄率68%～92%,平均81%,1例完全闭塞。6例患者均行PDAA弹簧圈栓塞术,腹腔干动脉狭窄均未处理,手术时间60～110 min,平均(76.7±13.5)min;4例破裂患者栓塞治疗后出血停止,2例未破裂动脉瘤栓塞后瘤体消失,术后患者住院时间7～13 d,平均(10±2.3)d。随访9～15个月,未出现动脉瘤复发及内脏缺血表现。结论:PDAA合并腹腔干动脉狭窄单独行动脉瘤栓塞治疗是安全有效的,腹腔干动脉狭窄不处理并未出现内脏缺血表现,也未增加动脉瘤复发的风险。     

Ruptured distal middle cerebral artery aneurysm: Case report

INTRODUCTIONThis report describes a rare case of a distal middle cerebral artery (dMCA) aneurysm.PRESENTATION OF CASEThat developed a right intracerebral haematoma and subarachnoid haemorrhage. It was treated by surgical exploration and clipping via pterional approach.DISCUSSIONClinical findings and surgical approaches of dMCA aneurysm are different from proximal middle cerebral artery (MCA) aneurysms. Microneurosurgical clipping is the most effective treatment of dMCA aneurysm.CONCLUSIONWe comprehensively review the literature related to these rare aneurysms within the temporal lobe, surgical anatomy of the dMCA aneurysm.     

Ruptured frontopolar artery aneurysm: two cases

We report two very rare cases of subarachnoid hemorrhage due to a ruptured frontopolar artery aneurysm in the cingulate sulcus. Only two surgically treated cases have been reported. Case 1: A 69-year-old woman suffered headache and was admitted to our hospital the next day. Computed tomography (CT) revealed focal subarachnoid hemorrhage (SAH) in the interhemispheric fissure. Cerebral angiography on admission failed to show an aneurysm, but follow-up study on day 14 revealed a small aneurysm in the cingulate sulcus at the origin of the frontopolar artery arising from the callosomarginal trunk. The aneurysm was successfully clipped on day 15 and the post-operative course was uneventful. Case 2: A 43-year-old man was transferred to our hospital complaining of severe headache. CT revealed diffuse SAH in the basal and interhemispheric cistern. Cerebral angiography showed an aneurysm at the origin of the callosomarginal trunk arising from the anterior communicating artery complex and another at the callosomarginal-frontopolar bifurcation in the cingulate sulcus. Both aneurysms were successfully clipped on the day of admission, and the frontopolar artery aneurysm was shown to be the cause of the SAH.     

脾动脉瘤的临床特征与腔内治疗：附30例报告

背景与目的:脾动脉瘤(SAA)是一类少见、具有潜在致命破裂风险的内脏动脉瘤疾病。SAA的传统手术方式为开腹切除动脉瘤及脾脏。近年来,随着介入技术和材料的发展,SAA的腔内治疗越来越普及。相比于开放手术,腔内治疗具有微创、简便、术后快速康复的优势。本文探讨SAA腔内治疗的有效性和安全性。方法:回顾性分析2012年1月—2019年12月在中南大学湘雅医院血管外科治疗的30例SAA患者资料,并介绍了我科治疗SAA的3种介入手术方式。结果:患者30例均行腹部CTA明确SAA诊断,其中近脾门型17例,中间型9例,远脾门型4例;囊状动脉瘤19例,梭形动脉瘤11例。30例均采取腔内治疗方法,其中21例行SAA栓塞术,6例行脾动脉支架置入术,3例行脾动脉裸支架置入+栓塞术。患者术后平均住院时间4 d,平均住院费用5万元,术后发生腹痛、呕吐、发热等症状10例,症状均在3 d以内缓解,无后遗症发生。发生穿刺点出血1例,保守治疗好转后出院。住院期间无急性脾梗死发生,没有发生需再次手术的并发症。22例患者术后随访3～6个月,CT复查示动脉瘤完全血栓化,未见造影剂进入;出现无症状局灶性脾梗死5例。结论:介入腔内手术可在保留脾脏的情况下治疗SAA,治疗效果确切,且创伤小,术后恢复快,并发症发生概率低,住院时间短,费用相比开放手术无明显增加。腔内治疗可作为绝大部分SAA的首选治疗,具体手术方式需根据术前CTA显示的SAA形态及位置来决定。     

保持载瘤动脉通畅的椎动脉夹层动脉瘤治疗：附28例报告

目的:探讨保持载瘤动脉的椎动脉夹层动脉瘤治疗方法及效果。方法:回顾性分析2013年1月—2018年10月28例接受保持载瘤动脉通畅治疗的颅内椎动脉夹层动脉瘤患者的临床资料。结果:28例患者中,未破裂12例,破裂16例,平均年龄(51.8±7.5)岁。28例患者手术技术成功率为100%。5例未破裂患者采用单纯2枚及2枚以上支架植入,术后即刻造影显示动脉瘤内造影剂滞留,随访造影发现动脉瘤消失或动脉瘤明显变小,Raymond分级Ⅰ级3例(3/5),Ⅱ级例2(3/5)。另外23例患者采用2枚重叠支架辅助弹簧圈栓塞,术后即刻造影显示,动脉瘤Raymond分级Ⅰ级11(11/23)例,Raymond分级Ⅱ级5(5/23)例,Raymond分级Ⅲ级7(7/23)例,其中19例(19/23)获随访(14.5±7.9)个月。随访造影发现动脉瘤Raymond分级Ⅰ级16例(16/19),Raymond分级Ⅱ级3例(3/19),无Raymond分级Ⅲ级病例。16例破裂患者中,2例发生支架内血栓形成或术后穿支事件,给予溶栓治疗后消退。预后mRS评分≤2分27例(27/28),≥3分1例(1/28)。结论:保持载瘤动脉通畅,多支架或多支架辅助弹簧圈栓塞椎动脉夹层动脉瘤可以获得较好的临床结果。     

Ruptured spontaneous splenic artery aneurysm: A case report and review of the literature

INTRODUCTION

Splenic artery aneurysm is a rare condition, however, potentially fatal. The importance of splenic artery aneurysm lies in the risk for rupture and life threatening hemorrhage.

PRESENTATION OF CASE

This is a case of a ruptured splenic artery aneurysm in a 58-year-old lady. She presented with hypovolemic shock and intra-peritoneal bleeding. Diagnosis was confirmed by CT angiography and she was managed by operative ligation of the aneurysm with splenectomy and distal pancreatectomy.

DISCUSSION

The literature pointed the presence of some risk factors correlating to the development of splenic artery aneurysm. In this article we discuss a rare case of spontaneous (idiopathic) splenic artery aneurysm and review the literature of this challenging surgical condition.

CONCLUSION

Splenic artery aneurysm needs prompt diagnosis and management to achieve a favorable outcome, high index of suspicion is needed to make the diagnosis in the absence of known risk factors.     

腹腔干动脉瘤九例的诊断与治疗

目的 探讨腹腔干动脉瘤的诊断与治疗方法。方法 回顾总结9例腹腔干动脉瘤的诊治情况。结果 本组腹腔干动脉瘤9例,位于起始部2例。主干2例,分叉处5例,术前经CTY下实5例,行磁共振造影（MRA）检查证实2例,数字减影动脉造影（DSA）证实5例,均予手术治疗,其中肝动脉重建例,肝动脉及脾动脉结扎、脾切除2例,腹腔干重建4例,本组围手术期无死亡。结论 腹腔干动脉诊断一旦明确,应尽早手术治疗,行腹腔干或肝动脉重建术是最佳的手术方式。     

肠系膜动脉瘤破裂出血的诊治分析：附8例报告

背景与目的 肠系膜动脉瘤是一种罕见的疾病,大部分患者确诊时动脉瘤已出现破裂大出血,病情危重,治疗风险大。本文回顾性分析肠系膜动脉瘤破裂患者的病例特点,探讨该疾病诊断和治疗方式的选择。方法 回顾性分析于2016年1月—2020年12月在湖南省郴州市第一人民医院血管外科收治的8例肠系膜动脉瘤破裂出血患者的临床资料和随访情况。结果 8例患者行腹部CTA或腹部增强CT明确诊断为肠系膜动脉瘤破裂出血。患者均行急诊手术治疗,其中6例行腹腔动脉造影+栓塞术;1例因腔内治疗失败后选择行开放手术;1例首选开放手术。8例患者均抢救成功,3例患者腔内治疗术后出现腹痛腹胀,药物保守治疗好转;1例患者开放手术术后出现创伤性胰腺炎,予以药物治疗治愈。所有患者住院期间均无再出血、肠缺血、肠坏死等并发症与再次手术。8例患者均随访12个月,患者正常饮食后无腹痛腹胀不适,无再次出血;复查腹部增强CT或CTA提示动脉瘤栓塞良好,血肿明显吸收。结论 临床医生要提高对肠系膜动脉瘤破裂出血疾病的认识和警惕,及时做出正确诊断。手术治疗方案可分为开放手术和腔内治疗,均安全和有效,术前应根据患者病情、瘤体位置和形态决定具体手术方案。     

自发性孤立性肠系膜上动脉夹层的诊治：附3例报告

目的：探讨自发性孤立性肠系膜上动脉夹层（SISMAD）的诊治策略。 方法：回顾性分析中南大学湘雅医院血管外科2012年10月—2013年5月期间收治的3例SISMAD患者的临床资料,总结SISMAD患者的临床表现和影像学特征、治疗策略的选择以及预后情况。 结果：3例SISMAD患者中男2例,女1例;临床症状均表现为腹痛,伴恶心呕吐;治疗前CTA均示肠系膜上动脉内由内膜片分割形成的真假腔,其中Sakamoto II型2例、III型1例;均未合并夹层破裂出血或肠坏死。3例均在低分子肝素钙抗凝治疗的基础上再行腔内支架治疗,术后无严重并发症发生,腹痛症状缓解。随访2~8个月,3例均存活,症状消失,支架通畅。 结论：对有症状的疑似SISMAD的患者,应行CTA检查明确诊断;未合并夹层破裂出血、肠坏死SISMAD的患者,抗凝治疗的基础上腔内支架治疗是一种安全、有效的方法。     

毒品注射致股动脉假性动脉瘤破裂出血的诊治

目的探讨注射毒品引起股动脉假性动脉瘤形成并破裂出血的诊断与治疗方法。方法回顾性分析2003年3月—2009年12月收治的22例因反复注射毒品致股动脉假性动脉瘤形成并破裂出血患者的临床资料。结果 22例患者均接受手术治疗,术中行瘤体切除、清创后,8例行股动脉破口修补术;4例行破口两侧股动脉结扎术;10例行髂外动脉-股动脉人工血管移植术。22例均手术成功,手术后早期出现人工血管与股动脉吻合口破裂出血1例,急诊手术重新吻合,随后出现切口感染,经换药后切口愈合。术后患侧下肢功能均好。随访6个月至7年,平均3年。1例患者术后2年出现人工血管感染,1例出院后14d发生吻合口出血,均经再次血管吻合治愈;2例股动脉结扎患者遗留轻间歇性跛行。结论治疗股动脉假性动脉瘤形成并破裂出血的手术方式,以股动脉假性动脉瘤切除+清创+股动脉修补术最为简单、安全有效;人工血管移植术疗效确定,能最大限度保证患肢血供;股动脉修补或结扎术在选择病例中也是有效的治疗方法。     

Ruptured aneurysm arising from the anterior medullary segment of the posterior inferior cerebellar artery: report of two cases

In the distal posterior inferior cerebellar artery (PICA), saccular aneurysms originating at the first proximal segment, anterior medullary segment (AMS), are unusual but important due to the presence of critical perforators that branch off the PICA and supply the lower brainstem. Because the anatomy of the PICA varies, no standard treatment strategy has been agreed upon to date. We successfully treated 2 patients with open surgery. One was a 53-year-old man who presented with Hunt-Hess grade 2 subarachnoid hemorrhage (SAH). Cerebral angiography revealed an irregular fusiform AMS aneurysm extending to the lateral medullary segment. Intraoperative inspection showed some perforators to the brain stem branching from just proximal and distal to the aneurysm. The patient underwent aneurysmal trapping and occipital artery-PICA anastomosis to preserve perforators flow, and was discharged without any neurological deficits. Another patient, a 74-year-old woman, was transferred to our institute because she suddenly became comatose. She was found to have a ruptured saccular AMS aneurysm. On the 15th day after the event, she underwent successful aneurysmal clipping preserving perforators by surgical inspection. As both patients manifested intra-aneurysmal thrombosis, we suggest that patients presenting with AMS aneurysms that display unusual features require careful management and judicious choice of treatment. Based on our experience we suggest that direct surgery, which facilitates the identification of perforators and allows for revascularization, is the appropriate treatment choice in patients who present with this entity.     

Ruptured popliteal artery aneurysm: a case report

A high index of suspicion for popliteal aneurysms must be present when evaluating a popliteal mass. Though typically pulsatile, in the presence of chronic thrombosis, the absence of a pulse may make the diagnosis even more difficult. A case is presented that illustrates this point, where an 83-year-old man presents following the biopsy of what turned out to be a very large popliteal aneurysm. In the presence of chronic thrombosis and adequate collateral flow, decompression and ligation of any feeding vessels is typically sufficient. These patients must be followed lifelong for the development of other associated aneurysms.     

Ruptured ovarian artery aneurysm: a case report

Ruptured aneurysms of the ovarian artery are exceedingly rare. Five cases have been previously reported in the English-language literature, all occurred in the early postpartum period. The present report details another such case, the first, to my knowledge, to have been demonstrated by angiography or to have been treated nonoperatively.     

腹主动脉瘤腔内修复术中髂动脉瘤的处理策略

目的:探讨腹主动脉瘤合并髂动脉瘤的腔内修复术(EVAR)方法。方法:回顾性分析2007年8月—2014年3月35例腹主动脉瘤合并髂动脉瘤行EVAR术患者资料,其中9例合并单侧髂内动脉瘤,1例合并双侧髂内动脉瘤,14例合并单侧髂总动脉瘤(直径18 mm),11例合并双侧髂总动脉瘤,所用腔内技术包括栓塞髂内动脉瘤后覆盖,髂内动脉瘤单纯覆盖,"喇叭口"支架,以及"三明治"技术重建一侧髂内动脉等。结果:所有腔内技术均获得成功,手术时间(125±40)min,出血量(173±65)m L。术中发现内漏8例(22.9%),其中I型内漏4例(近端2例,远端2例)均经球囊扩张后内漏消失,III型内漏1例,经扩张及部分加弹簧圈栓塞后内漏消失,II型内漏2例及IV型内漏1例,均未予处理。35例术后随访6~60个月,无动脉瘤破裂,2例术后6个月发现腹主动脉瘤体增大,造影确诊远端I型内漏,经弹簧圈栓塞后内漏消失,其余33例瘤体直径无增大。结论:对于合并髂动脉瘤的腹主动脉瘤患者,有效处理髂内动脉,然后根据髂总动脉直径选择合适的治疗方法可以达到理想的近期效果。     

Ruptured aneurysm at the choroidal branch of the posterior inferior cerebellar artery: a case report and review of the literature

BACKGROUND: The authors present a rare case of a ruptured aneurysm at the choroidal branch of the posterior inferior cerebellar artery (PICA). CASE DESCRIPTION: A 77-year-old female was admitted to our institute because of sudden onset of severe headache and vomiting. Radiologic examination revealed intraventricular hemorrhage caused by rupture of the aneurysm at the choroidal branch of the PICA. The fusiform aneurysm was resected after ligation via a midline suboccipital approach. CONCLUSIONS: The conclusions drawn from this experience and a review of the literature include the following: (1) the aneurysm at the branch of the PICA is frequently associated with anomalies of the vascular structure, particularly in hypoplasty of the contralateral PICA; (2) hemodynamic stress is speculated to be a causative factor of these lesions; (3) cases with hypoplasty of the contralateral PICA have the possibility of developing nonmycotic peripheral aneurysms at the branch of the PICA; (4) these aneurysms should be managed immediately because of the high risk of rebleeding.     

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     

Ruptured anterior spinal artery aneurysm: a case report

BACKGROUND

Spinal artery aneurysms are rare, and are usually found in association with arteriovenous malformations or coarctation of the aorta.

CASE REPORT

A 42-year-old man with a ruptured anterior spinal artery aneurysm is presented here. He experienced subarachnoid hemorrhage, which was confirmed by computed tomography. Magnetic resonance imaging revealed an aneurysm in front of the upper part of the medulla. Angiography demonstrated bilateral vertebral artery occlusion. Distal vertebral arteries and the basilar artery were perfused via the dilated anterior spinal artery, which originates in the right subclavian artery. The aneurysm was located at the distal part of the anterior spinal artery, and was successfully clipped through a lateral suboccipital craniotomy 2 months after bleeding from the aneurysm. After rehabilitation, the patient was able to walk with no apparent neurologic deficit.

CONCLUSIONS

This case suggests that the anterior spinal artery as a collateral route after bilateral vertebral arery occlusion is under hemodynamic stress, resulting in aneurysm formation and rupture.     

腘动脉瘤开放手术与腔内修复术的对比研究

目的:比较腘动脉瘤(PAA)开放手术与腔内修复术的治疗效果。方法:回顾性分析2008年1月—2017年12月收治的33例PAA患者的临床资料,其中22例(23条肢体)行开放手术(开放手术组),11例(13条肢体)行腔内修复术(腔内修复组),分析、比较两组患者的一般资料、围手术期情况、随访结果。结果:腔内修复组患者年龄与高血压病合并症比例明显大于开放手术组(χ~2=8.250,P=0.008;χ~2=6.203,P=0.024),而两组在其他合并症、术前瘤体直径、术后伤口并发症方面均无统计学差异(均P0.05)。开放手术组均在全麻下完成手术,腔内修复组6例(54.5%)全麻下完成腔内手术(χ~2=12.257,P=0.002)。腔内修复组术后住院时间与总住院时间明显少于开放手术组(t=-4.221,P=0.000;t=-3.090,P=0.002)。中位随访时间36个月(1~120个月),开放手术组有5例再次干预,其中2例行截肢术;腔内修复组有2例再次干预。Kaplan-Meier分析显示两组患者免于再次干预率的差异无统计学意义(P0.05)。结论:对于高龄、外科手术风险高、解剖学条件合适、流出道情况良好的PAA患者,腔内修复术短中期疗效确切、住院时间短、围手术期恢复快,可替代外科手术成为首选治疗方案。