胰十二指肠动脉瘤合并腹腔干动脉狭窄的介入治疗：附6例报告

目的:探讨胰十二指肠动脉瘤(PDAA)合并腹腔干动脉狭窄的治疗时机及方式的选择。方法:回顾性分析6例PDAA患者临床资料,其中4例因动脉瘤破裂出血,2例未出血被偶然发现,6例均合并腹腔干动脉狭窄或闭塞,所有患者行腔内动脉瘤栓塞治疗。结果:6例患者中,男5例,女1例;年龄42～81岁,平均59.8岁;瘤径8～21 mm,平均14.6 mm;2例为真性动脉瘤,4例为假性动脉瘤;4例位于胰十二指肠下后动脉,2例位于胰十二指肠下前动脉;5例患者有腹腔干动脉狭窄,狭窄率68%～92%,平均81%,1例完全闭塞。6例患者均行PDAA弹簧圈栓塞术,腹腔干动脉狭窄均未处理,手术时间60～110 min,平均(76.7±13.5)min;4例破裂患者栓塞治疗后出血停止,2例未破裂动脉瘤栓塞后瘤体消失,术后患者住院时间7～13 d,平均(10±2.3)d。随访9～15个月,未出现动脉瘤复发及内脏缺血表现。结论:PDAA合并腹腔干动脉狭窄单独行动脉瘤栓塞治疗是安全有效的,腹腔干动脉狭窄不处理并未出现内脏缺血表现,也未增加动脉瘤复发的风险。

Interventional therapy for pancreaticoduodenal artery aneurysm with celiac axis stenosis: a report of 6 cases

Objective: To investigate the treatment timing and method for pancreaticoduodenal artery aneurysm (PDAA) accompanied with celiac axis stenosis.  Methods: The clinical data of 6 patients with PDAA were retrospectively analyzed. Diagnosis was made in 4 patients due to aneurysm rupture/bleeding and in 2 patients by accident. All the 6 patients had a concomitant celiac axis stenosis or occlusion, and all of them underwent endovascular aneurysm embolization. Results: Of the 6 patients, 5 cases were males and one case was female, whose age ranged from 42 to 81 years, with an average age of 59.8 years; the aneurysm size ranged from 8 to 21 mm, with an average of 14.6 mm; 2 cases had a true aneurysm and 4 cases had a pseudoaneurysms; the lesion was located in the posterior inferior pancreaticoduodenal artery in 4 cases, and in the anterior inferior pancreaticoduodenal artery in 2 cases; 5 patients had celiac axis stenosis, the stenosis rate ranged from 68% to 92%, with an average of 81%, and one patient had complete celiac axis occlusion. All the 6 patients underwent embolization coil occlusion of the PDAA and, in all of them, no treatment was performed for the celiac axis stenosis. The operative time ranged from 60 to 110 min, with an average of (76.7±13.5) min. After aneurysm embolization, the bleeding stopped in the 4 patients with ruptured aneurysm, and the aneurysm spontaneously disappeared in the two patients with unruptured aneurysm. The length of postoperative hospital stay ranged from 7 to 13 d, with an average of (10±2.3) d. Followed-up was conducted for 9 to 15 months, and no aneurysm recurrence or visceral ischemia occurred. Conclusion: Embolization alone is safe and effective treatment for PDAA with celiac axis stenosis. Leaving the celiac axis stenosis untreated will not result in visceral ischemia, and increase the risk of aneurysm recurrence.