内脏动脉瘤的外科治疗

目的 探讨内脏动脉瘤的外科治疗方法。方法 回顾性分析2002年2月至2010年6月收治的19例内脏动脉瘤患者外科治疗的临床资料，包括脾动脉瘤7例、肝右动脉瘤1例、胃左动脉瘤1例、胰十二指肠动脉瘤3例、胃十二指肠动脉瘤2例、肠系膜上动脉瘤、结肠中动脉瘤和左结肠动脉瘤各1例、肾动脉瘤2例。其中破裂12例。按照手术方式分为两组，介入栓塞治疗组13例，开放手术组6例。结果 4例栓塞后再出血，2例行手术探查止血、2例行二次栓塞后都得以成功止血。8例动脉瘤破裂伴休克患者术后均停止出血。1例胰十二指肠动脉瘤栓塞后出现十二指肠不全梗阻。2例脾动脉瘤患者术后出现部分脾梗死。术后随访18例，随访2 ～ 103个月，无动脉瘤复发。结论 以支配脏器和动脉解剖的特点作为内脏动脉瘤选择手术方案的主要依据。腔内治疗和开放手术在治疗内脏动脉瘤方面均有效，而对于假性动脉瘤破裂患者，腔内治疗效果满意。

Surgical treatment of visceral artery aneurysms

Objective To analyze the surgical treatment of visceral artery aneurysm (VAAs).Method Clinical data of 19 patients surgically treated for visceral artery aneurysm in our hospital from Feb 2002 to Jun 2010 were reviewed. There were 7 cases of splenic, 1 of right hepatic, 1 of left gastric,3 of pancreaticoduodenal,2 of gastroduodenal, 1 of superior mesenteric, 1 of middle colic, 1 of left colic and 2 of renal artery aneurysms. Rupture of the aneurysm occurred in 12 patients. Transcatheter arterial embolization was performed in 13 cases, other 6 cases received open surgical treatment. Results Four patients suffered from recurrent bleeding after first embolization, 2 of those received surgery to stop bleeding, another 2 were successfully managed by second embolization. Bleeding were rapidly controlled in 8 ruptured patients associated with shock. Duodenum incomplete obstruction developed in 1 patient after pancreaticoduodenal artery embolization, another 2 patients suffered from partial splenic infarction after splenic artery operation. 18 cases were followed-up from 2 to 103 months without aneurysm recurrence. Conclusions Endovascular embolization and open surgery for VAAs are safe and effective, endovascular intervention and embolization is especially life saving for ruptured pseudo-aneurysm cases.