脾动脉瘤的诊断和治疗

目的：总结16例脾动脉瘤的外科诊治经验。方法：回顾性分析收治的16例脾动脉瘤患者的临床资料。其中男4例，女12例，经超声多普勒、CT血管造影（CTA）等检查发现脾动脉瘤15例，另1例术中探查发现。手术治疗11例，其中脾动脉瘤破裂行急诊手术4例，择期性手术7例，手术包括脾动脉瘤及脾切除9例，同时切除胰尾3例,脾动脉瘤切除、脾动脉重建1例，脾动脉瘤切除、近远端脾动脉结扎1例。另外行脾动脉瘤介入栓塞3例，非手术治疗2例。结果：手术及介入治疗的14例患者治疗后未发生严重的并发症，无死亡，均康复出院。术后随访0.5~19.0年，平均8.4年。11例手术及介入治疗者中，2例分别手术后3，7年死于其他疾病，另9例情况良好。2例非手术治疗者已分别随访3，5年，脾动脉瘤无变化。结论：脾动脉瘤女性多发；CT血管造影和多普勒超声等可明确诊断；早期切除动脉瘤或介入栓塞术是防止破裂出血导致死亡的有效方法。

Diagnosis and management of splenic artery aneurysms

Objective:To summarize an experience in the management of 16 cases of splenic artery aneurysm.Methods :The clinical data of 16 patients with splenic artery aneurysm treated from January 1980 to April 2008, were retrospectively reviewed. There were 12 female and 4 male patients. Fifteen patients were diagnosed by Doppler ultrasonography and CT angiography (CTA) and 1 patient was diagnosed during operation. Four patients with ruptured splenic artery aneurysm underwent emergent operations, 7 patients underwent elective surgery or interventional therapy, and 2 patients received close follow-up without surgical treatment. The surgical procedures included aneurysmectomy and splenectomy in 9 patients, distal pancreatectomy in 3cases; aneurysmectomy and reconstruction of splenic artery in one patient; aneurysmectomy and splenic artery ligation in one patient; interventional embolization of the splenic aneurysm in 3 patients. Results:All of the 14 patients who underwent surgical treatment recovered well postoperatively; there were no deaths or severe complications in the perioperative period. Of the 14 patieuts,11were followed up for 0.5~0.9.0 years with average 8.4 years. 9 patients well alive well. 2 patients died of other disease. Two patients undergoin non-operative management were observed for 3, 5 years,respectively,the aneurysms were no change.Conclusions:Splenic artery aneurysm is more common in females. CT angiography (CTA) and Doppler ultrasonography are useful examinations to confirm the diagnosis. Aneurysmectomy or interventional embolization is effective treatment to prevent lethal rupture.