内脏动脉瘤的诊断与治疗

目的　探讨内脏动脉瘤的诊断和治疗方法。方法　回顾性总结我院40 多年来收治的62 例内脏动脉瘤的临床经验。结果　本组包括肝动脉瘤15 例,胃胰十二指肠动脉瘤13 例,脾动脉瘤16 例,肾动脉瘤6 例,肠系膜上、下动脉瘤分别为5 例和1 例,腹腔干动脉瘤3 例,网膜动脉瘤3 例。本组自发性破裂大出血29 例,其中破裂入胆管14 例,上消化道10 例,腹腔及腹膜后5 例。本组术前经内脏动脉造影确诊37 例,经磁共振( MRI) 及数字减影血管造影术( DSA) 确诊各2 例,另6 例由螺旋CT 动脉造影(SCTA) 诊断。手术治疗51 例,死亡9 例,动脉栓塞治疗6 例。结论　内脏动脉瘤术前临床诊断极为困难,选择性内脏动脉造影( 包括DSA) 最具诊断价值,一旦确诊应尽早手术治疗

Diagnosis and treatment of visceral artery aneurysm

Objective To evaluate the diagnosis and treatment of visceral artery aneurysms (VAA). Methods Abstract Objective To evaluate the diagnosis and treatment of visceral artery aneurysms (VAA). Methods The clinical data of 62 patients with VAA at our hospital during the past 40 years were reviewed retrospectively. Results Of 62 cases of VAA, the hepatic artery was involved in 15 patients, gastroduodenal pancreatic arteries in 13, splenic artery in 16 patients, renal artery in 16, superior mesenteric artery in 5, inferior mesenteric artery in 1, celiac artery in 3 and gastroepiploic artery in 3. Spontaneous rupture occurred in 29 patients. Of them, rupture into the biliary tract in 14 patients, into upper gastrointestinal tract in 10, and into abdominal cavity or retroperitonum in 5. Correct preoperative diagnosis was made by selective visceral arteriography in 37 cases, by MRI and DSA in 2 cases respectively, while by SCTA in 6 patients. Nine of 51 operated patients died; 6 patients were treated by selective embolization of the VAA. Conclusions Preoperative diagnosis of VAA is difficult. The most valuable diagnostic approach is selective visceral arteriography. Surgical therapy is recommended in most patients.