脾动脉瘤临床诊治分析(附12例报告)

目的:总结12例脾动脉瘤的临床诊断治疗经验。方法:对2001年1月至2007年6月华西医院诊治的12例脾动脉瘤作回顾性分析。结果:12例脾动脉瘤中伴动脉粥样硬化3例,门脉高压症2例,慢性胰腺炎2例,胰腺损伤后2例,胰尾肿瘤1例;其中自发性破裂大出血2例。11例经彩色多普勒、CT、磁共振血管造影(MRA)、选择性内脏动脉造影确诊,1例依靠手术探查确诊,没有1例能单独依靠临床表现明确诊断。本组中行动脉瘤切除加脾切除4例,单纯动脉瘤切除1例,动脉瘤近远端动脉结扎1例,动脉瘤体伴胰体尾部切除加脾切除1例,动脉介入栓塞1例,死亡2例。结论:脾动脉瘤一般起病隐匿,临床症状很少具有特征性表现,选择性内脏动脉造影最具有诊断价值。一旦确诊应及时根据病情选择微创介入栓塞治疗或尽早手术。

Diagnosis and Treatment of Splenic Aneurysm:A Report of 12 Cases

Objective:To summarize the experience of clinical management of 12 cases having splenic aneurysm(SA).Methods:Clinical data on 12 cases of SA treated from Feb 2001 to July 2007 were retrospectively analyzed.Results:Of 12 patients,3 had atherosclerosis,2 portal hypertension,2 chronic pancreatitis and 2 following the pancreatic trauma,and 1 pancreatic tail tumor.Meanwhile,3 of the 12 had spontaneous bleeding following rupture of the splenic artery.Eleven patients were accurately diagnosed by color duplex flow imaging,CT,MRA or selective visceral artery angiography,and 1 patient by operation.No patient was confirmed by clinical presentations only.Four patients were performed resection of splenic aneurysm and the spleen,and 1 patient had resection of spleen only.One patient was performed resection of pancreatic body and tail and splenectomy as well.One patient was treated through ligation of the proximal and distal neck of the aneurysms,and 1 patient through endovascular embolization.There were two deaths occured.Conclusion:Splenic aneurysms rarely arose and are of no characteristic clinical presentations.Selective visceral artery angiography had the best diagnostic value.As soon as the diagnosis was confirmed,the treatment of less traumatic endovascular embolization or surgical procedure should be employed.