脾动脉瘤手术切除与瘤腔内栓塞术的临床疗效分析  

The effect of open surgery and endovascular repair on splenic aneurysms

作　　者：李俊[1] 张志功[1] 陈智勇[1] 查斌山[1] 刘斌[1] 叶雨生[1] 余康敏[1] 李永生[1] 魏猛[1] 朱化刚[1] LI Jun;ZHANG Zhi-gong;CHEN Zhi-yong(Department of Vascular Surgery,First Affiliated Hospital,Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院血管外科,合肥230022

出　　处：《肝胆外科杂志》2019年第6期433-437,共5页Journal of Hepatobiliary Surgery

摘　　要：目的本研究旨在探讨不同手术方法在脾动脉瘤治疗中的安全性和有效性。方法回顾性分析2013年1月至2018年12月期间脾动脉瘤病人39例。分为脾动脉瘤手术切除19例和瘤腔内栓塞术组20例。比较术前临床资料、手术方式、术后并发症、死亡率、住院时间等指标。结果两组术前临床资料差异无统计学意义。脾动脉瘤手术切除组中具体手术方式:脾动脉瘤切除术(8例),脾动脉瘤切除术联合脾切除术(5例),脾动脉瘤切除和脾动脉重建(5例)和腹腔镜脾动脉瘤切除联合脾切除术(1例)。所有患者均系全身麻醉。手术成功率100%,平均手术时间为186.7±58.6分钟。在瘤腔内栓塞组,所有患者均系局部麻醉下行脾动脉瘤弹簧圈栓塞术。手术成功率100%,平均手术时间是74.9±19.5分钟。相比脾动脉瘤切除手术,瘤腔内栓塞术具有手术时间短的优点,差异有统计学意义(P<0.001)。两组均没有发现早期死亡病例和30天死亡病例。平均住院时间为7.2±3.6天。和脾动脉瘤切除术相比,瘤腔内栓塞组的住院时间更短更有优势(4.9±2.8 vs9.5±4.5天,P<0.001)。结论脾动脉瘤切除术和瘤腔内栓塞在治疗脾动脉瘤同样有效可行。瘤腔内栓塞术具有较小的创伤性、手术时间明显缩短,住院时间短,恢复快。Objective This study was designed to investigate the safety and efficacy of different surgical procedures in the treatment of splenic aneurysms.Methods A retrospective analysis of 39 patients with splenic aneurysms from January 2013 to Decernber 2018.There were 19 cases of splenic aneurysm surgical resection and 20 cases of intratumoral embolization.Compare preoperative clinical data,surgical methods,postoperative complications,mortality,hospital stay and other indicators.Results There was no significant difference in preoperative clinical data between the two groups.Specific surgical methods in the surgical resection group of splenic aneurysm:splenic aneurysm resection(8 cases),splenic aneurysm resection combined with splenectomy(5 cases),splenic aneurysm resection and splenic artery reconstruction(5 cases)and laparoscopy Splenic aneurysm resection combined with splenectomy(1 case).All patients were general anesthesia.The success rate of surgery was 100%,and the average operation time was 186.7±58.6 minutes.In the embolization group in the tumor cavity,all patients underwent local anesthesia for sprain aneurysm coil embolization.The success rate of surgery was 100%,and the average operation time was 74.9±19.5 minutes.Compared with splenic aneurysm resection,intratumoral embolization has the advantage of short operation time,and the difference is statistically significant(P<0.001).No early deaths and 30 days of death were found in either group.The average hospital stay was 7.2±3.6 days.Compared with splenic aneurysm resection,the length of hospital stay in the embolization group was shorter(4.9±2.8 vs 9.5±4.5 days,P<0.001).Conclusion Splenic aneurysm resection and intracavitary embolization are equally effective in the treatment of splenic aneurysms.Endovascular embolization has less traumaticitv,significantly shorter operative time,shorter hospital stay,and faster recovery.

关 键 词：脾动脉瘤 脾动脉瘤切除术 瘤腔内栓塞 

分 类 号：R735.9[医药卫生—肿瘤]