脾动脉瘤开放手术和腔内手术治疗的临床疗效分析  

Analysis of clinical efficacy in open surgery and endovascular surgery for splenic artery aneurysm

作　　者：蒋德龙 姜波[1] Jiang Deong;Jiang Bo(Department of Vascular Surgery,The First Hospital of China Medical University,Shenyang 110002,China)

机构地区：[1]中国医科大学附属第一医院血管外科,沈阳110002

出　　处：《中华血管外科杂志》2024年第2期100-104,共5页Chinese Journal of Vascular Surgery

基　　金：辽宁省自然科学基金(2022-MS-189)。

摘　　要：目的探讨脾动脉瘤(SAA)开放手术和腔内手术治疗的围术期疗效。方法本研究为回顾性队列研究。回顾性分析2015年3月至2023年7月中国医科大学附属第一医院血管外科行手术治疗的86例SAA患者的临床资料,根据手术方式分为开放手术组(24例)和腔内手术组(62例)。比较两组患者一般资料及围术期情况。结果开放手术组中,SAA切除+脾切除术18例,SAA切除+脾切除+胰腺远端部分切除术6例。腔内手术组中,SAA栓塞术57例,覆膜支架隔绝术3例,SAA栓塞+裸支架植入术2例。开放手术组近脾门型SAA的比例(79.2%比45.2%,χ^(2)=8.950,P=0.011)和有症状患者的比例(50.0%比16.1%,χ^(2)=10.427,P=0.001)高于腔内手术组,差异有统计学意义。两组年龄、性别、合并症等资料差异无统计学意义(均P>0.05)。与开放手术组相比,腔内手术组的手术时间[(3.45±1.64)h比(1.48±0.70)h,t=-6.328,P<0.001]及住院时间[(21.42±11.58)d比(8.45±4.19)d,t=-5.858,P<0.001]更短,术后总并发症发生率(25.0%比1.6%,χ^(2)=9.722,P=0.002)和术后血小板升高发生率(70.8%比3.2%,χ^(2)=45.948,P<0.001)更低,差异均有统计学意义。结论开放手术和腔内手术均为治疗SAA的有效方法,手术方式的选择应根据患者具体情况而定。腔内手术具有手术时间短、住院时间短、创伤小、恢复快的优势。ObjectiveTo investigate the perioperative efficacy of open surgery and endovascular surgery for splenic artery aneurysm(SAA).MethodsIn this retrospective cohort study,86 patients with SAA who underwent surgical treatment at the Department of Vascular Surgery of the First Affiliated Hospital of China Medical University from March 2015 to July 2023 were retrospectively analyzed,including 24 cases in the open surgery group and 62 cases in the endovascular surgery group.General data and perioperative conditions of the two groups were compared and analyzed.ResultsIn the open surgery group,18 cases underwent SAA excision+splenectomy,and 6 cases underwent SAA excision+splenectomy+partial distal pancreatectomy.In the endovascular surgery group,57 cases underwent SAA embolization,3 cases underwent stent-graft exclusion,and 2 cases underwent SAA embolization+bare metal stent implantation.The proportion of tumors located at the splenic hilum(79.2%vs.45.2%,χ^(2)=8.950,P=0.011)and the proportion of symptomatic patients(50.0%vs.16.1%,χ^(2)=10.427,P=0.001)in the open surgery group were higher than those in the endovascular surgery group,with statistically significant differences.There were no statistically significant differences in age,gender,and comorbidities between the two groups(all P>0.05).Compared with the open surgery group,the endovascular surgery group had a shorter operation time[(3.45±1.64)h vs.(1.48±0.70)h,t=-6.328,P<0.001],a shorter hospital stay[(21.42±11.58)d vs.(8.45±4.19)d,t=-5.858,P<0.001],a lower postoperative complication rate(25.0%vs.1.6%,χ^(2)=9.722,P=0.002)and a lower postoperative incidence of platelet elevation,all with statistically significant differences.ConclusionBoth open and endovascular surgery are safe and effective in SAA treatment,and the choice of surgical method should be based on the specific conditions of the patient.Endovascular surgery has the advantages of shorter surgery time,shorter hospitalization,less trauma,and faster recovery.

关 键 词：脾动脉瘤 开放手术 腔内手术 

分 类 号：R654.3[医药卫生—外科学]