摘要
目的探讨内脏动脉瘤(VAA)的治疗方法及其安全性、有效性。方法回顾性分析2012~2018年海南省人民医院血管外科18例VAA患者的临床资料。真性动脉瘤10例、假性动脉瘤8例,均为单发,其中脾动脉瘤7例,肾动脉瘤3例,肠系膜上动脉瘤4例,胃十二指肠动脉瘤2例,肝动脉瘤2例。腔内介入治疗13例:瘤腔栓塞术9例,瘤腔内隔绝术4例;开腹手术治疗5例:瘤体切除+动脉重建术3例,动脉瘤切除术2例。结果腔内介入手术治疗成功率92.3%(12/13),开腹手术治疗成功率100%(6/6,包括介入转开腹的1例)。患者全部获得随访,时间6~48个月,对比治疗前后数字减影血管造影及CT资料进行分析,动脉瘤消失或完全隔绝于循环之外达100%,未见动脉瘤破裂及复发、感染;无严重并发症或死亡;脾动脉瘤术后有2例出现脾梗死症状;肝动脉瘤、肾动脉瘤术后未见明显肝、肾功能异常;胃十二指肠动脉瘤及肠系膜上动脉瘤术后未见明显胰腺炎、肠道缺血等症状。结论VAA复杂多变,没有固定的术式,需根据患者的临床表现及影像学特征仔细分析、评估,只要应用得当,无论是开腹手术还是腔内介入手术,都是安全有效的。大部分VAA患者可首选腔内介入治疗,当腔内介入治疗失败时再转开腹手术也是可行的。
Objective To investigate the treatment of visceral artery aneurysm(VAA)and its safety and efficacy.Methods Clinical data of 18 patients with VAA admitted at Department of Vascular Surgery,Hainan General Hospital from 2012 to 2018 were retrospectively analyzed.All cases were solitary aneurysm(10 cases of true aneurysm,8 cases of pseudoaneurysm),including 7 cases of splenic artery aneurysm,3 cases of renal artery aneurysm,4 cases of superior mesenteric artery aneurysm,2 cases of gastroduodenal artery aneurysm and 2 cases of hepatic artery aneurysm.Endovascular treatment was performed in 13 cases,including 9 cases of embolotherapy and 4 cases of stent-implantation.Open surgery was performed in 5 cases,including 3 cases of aneurysmectomy plus artery reconstruction and 2 cases of aneurysmectomy.Results There were 13 cases of endovascular treatment,the success rate was 92.3%(12/13),and the success rate of laparotomy was 100%(6/6).After 6 to 48 months follow-up,digital substraction angiography and CT data before and after treatment were compared and analyzed.All aneurysms were disappeared or completely isolated from the circulation,no rupture,hemorrhage,recurrence,or infection were observed.No severe complications or death were found,splenic infarction symptoms occurred in 2 cases after surgery.No abnormalities of liver and kidney functions were found after treatments of hepatic and renal aneurysms.There were no obvious symptoms of pancreatitis and intestinal ischemia after operation for gastroduodenal artery aneurysms and superior mesenteric artery aneurysms.Conclusion VAA is unpredictable and complicated.There is no constant surgical method.Sufficient analysis and evaluation should be made according to the manifestations and imaging characteristics.As long as it is applied properly,it is safe and effective for both open surgery and endovascular surgery.Most patients with VAA could be given endovascular treatment as primary procedure.It is also feasible to convert to open surgery when endovascular treatment failed.
作者
曾昭凡
陈浩
李振振
吴鸿飞
肖占祥
Zeng Zhaofan;Chen Hao;Li Zhenzhen;Wu Hongfei;Xiao Zhanxiang(Department of Vascular Surgery,Hainan General Hospital,Haikou 570311,China)
出处
《中华血管外科杂志》
2019年第3期179-183,共5页
Chinese Journal of Vascular Surgery
关键词
内脏动脉瘤
开腹手术
介入治疗
Visceral artery aneurysm
Open surgery
Interventional therapy
