直径>5 cm的真性巨大脾动脉瘤诊治分析

目的探讨直径>5 cm的真性巨大脾动脉瘤的临床诊治特点。方法回顾性分析2013年5月至2019年11月收治的3例直径>5 cm的真性巨大脾动脉瘤患者的临床资料,并回顾相关文献。结果男性1例,女性2例,平均年龄60岁。腹痛、腹胀表现1例,左上腹部搏动性包块1例,查体发现1例;2例合并门脉高压症,女性患者均有2次妊娠史,1例左上腹触及搏动性包块,3例患者均行腹部强化CT检查。1例行介入支架腔内隔绝+瘤腔弹簧圈栓塞术;1例行开腹脾动脉瘤切除+脾切除术,术中出血少,未输血;1例行开腹脾动脉瘤切除+脾切除+脾静脉瘤切除+胆囊切除术,术中出血约400 ml,输注红细胞6 U,血浆600 ml。3例均治疗成功,无围术期死亡发生。介入治疗者随访2年3个月,无不适。手术者1例随访6年,预后较好,另1例失访。结论直径>5 cm的真性巨大脾动脉瘤罕见,具有独特的临床特征,手术切除仍是其主要且有效的治疗方法,预后较好。

Clinical analysis of the diagnosis and treatment of true giant splenic artery aneurysm with a diameter of>5 cm

Objective To explore the clinical features of the diagnosis and treatment of true giant splenic artery aneurysm with a diameter of>5 cm.Methods From May 2013 to November 2019,clinical data of 3 patients with true giant splenic aneurysms with a diameter of>5 cm,were analyzed retrospectively,meanwhile the relevant literature were also reviewed.Results There were 1 male and 2 female patients,with an average age of 60 years.There were 1 case of abdominal pain and distension,1 case of pulsatile mass in the left upper abdomen and 1 case diagnosed by physical examination,including 2 cases combined with portal hypertension.All of 2 female patients had a history of two pregnancies,including one case of a pulsatile palpable in the left upper abdomen.Three patients received enhanced CT examination of the abdomen.One patient underwent interventional stent endovascular exclusion+tumor cavity coil embolization.One patient underwent open splenic aneurysm resection+splenectomy with less intraoperative bleeding and no blood transfusion.One patient underwent open splenic aneurysm resection+splenectomy+splenic vein aneurysm resection+cholecystectomy with intraoperative bleeding of 400 mL and a transfusion of 6 U of red blood cells+600 mL of plasma.All 3 cases were successfully treated and no perioperative death occurred.The patient underwent interventional treatment was followed up for 2 years and 3 months without discomfort.One patient who underwent surgery was followed up for 6 years with a good prognosis,and the other was lost to follow-up.Conclusion True giant splenic aneurysms with a diameter of>5 cm is rare and has unique clinical features.Surgical resection remains its main and effective treatment with a better prognosis.