脾动脉瘤27例临床诊治

目的 总结脾动脉瘤（splenic artery aneurysm，SAAs）的诊治经验，探讨不同治疗方式安全性和可行性。方法 回顾性分析2002年5月至2020年6月浙江大学附属杭州市第一人民医院血管外科（n=25）和第二军医大学附属东方肝胆外科医院肝外四科（n=2）收治的27例SAAs患者资料，其中传统开腹手术4例（开腹治疗组）：2例行脾动脉瘤+脾脏切除术，2例行近远端动脉结扎脾动脉瘤旷置术；腔内治疗组9例，均采用Interlock^TM可解脱带纤维毛弹簧圈栓塞术；保守治疗组14例。分析患者术中和术后资料，评估不同治疗方式的安全性和有效性。结果 共纳入27例SAAs患者，共计29个瘤体，其中开腹治疗组瘤体直径（45.63±11.01）mm，腔内治疗组（27.67±5.29）mm，保守治疗组（12.54±2.40）mm。开腹治疗组和腔内治疗组均手术成功。开腹治疗组平均手术时间（3.50±0.62）h，术中出血量90～600 mL，平均住院费用（5.45±0.26）万元，住院时间（7.75±0.96）d。腔内治疗组平均手术时间（2.09±0.26）h，术中出血量（11.67±2.50）mL，平均住院费用（6.63±0.75）万元，住院时间（5.00±1.32）d。随访0～93个月，平均（42.96±26.15）个月，手术治疗（开腹治疗和腔内治疗）患者随访期间无死亡和瘤体再破裂等发生；保守治疗组随访6个月和12个月瘤体大小与确诊时无统计学差异，1例女性SAAs患者在妊娠期间出现瘤体增大和破裂，后急诊手术。结论 直径≥2 cm的脾动脉瘤，可根据瘤体大小、数目、部位、合并症和医院设备等综合评估后，采用开腹手术或腔内治疗，两种方式均安全可行；直径＜2 cm的大部分SAAs患者可采取保守治疗，定期随访安全有效。

Clinical diagnosis and treatment of splenic artery aneurysm: a report of 27 cases

Objective To summarize the experience of diagnosis and treatment of splenic artery aneurysms(SAAs) and investigate the safety and efficacy of the different treatments for SAAs. Methods Clinical data of 27 patients with SAAs treated between May 2002 to Jun. 2020 were analyzed retrospectively, of whom 2 patients were from Eastern Hepatobiliary Surgery Hospital, and the other 25 patients were from Affiliated Hangzhou First People’s Hospital. Four cases underwent conventional open surgery (COS): 2 patients had an isolation of splenic aneurysm with proximal and distal arterial legation, and 2 patients underwent resection of splenic aneurysm with splenectomy. Nine cases received endovascular therapy (ET) all with Interlock^TMspring coil embolization. Fourteen cases received conservative treatment. The operation time, postoperative complications, hospitalization time, cost and follow-up were compared. Results There were 29 tumors in the 27 SAAs patients. The mean tumor size in COS group was (45.63±11.01)mm, which was (27.67±5.29)mm in ET group and (12.54±2.40)mm in conservative group. Technical success (100%) was achieved in COS group and ET group. In COS group, the mean operative time was (3.50±0.62)h, the intraoperative blood loss was 90 to 600 mL, the average hospital cost was (5.45±0.26)×10⁴yuan, and the mean hospitalization time was (7.75±0.96)d; while the mean operative time was (2.09±0.26)h, the intraoperative blood loss was (11.67±2.50)mL, the average hospital cost was(6.63±0.75)×10⁴yuan and the mean hospitalization time was (5.00±1.32)d in ET group. The mean follow-up time for the 27 SAAs patients was (42.96±26.15)months, ranging from 0 to 93 months. No death or re-rupture of tumor occurred during the follow-up for patients who received surgery. In conservative treatment group, the tumor size was not changed significantly during the follow-up of 6 or 12 months. Tumor was enlarged and broken in only one femal SAA patient when in pregnancy, and then underwent emergency surgery. ConclusionFor SAAs with tumor size ≥2 cm, according to the comprehensive assessment of size, number, location, complications and hospital equipment, both open surgery and endovascular therapy are safe and feasible. And for most SAAs with tumor size <2 cm, conservative treatment and regular follow-up is safe.