复杂脾动脉瘤腔内介入治疗方法及疗效分析  

Endovascular interventional treatment for complicated splenic aneurysms and analysis of its curative efficacy

作　　者：张鑫 胡红耀[2] ZHANG Xin;HU Hongyao(Department of Medical Imaging,Affiliated Tianyou Hospital,Wuhan University of Science and Technology,Wuhan,Hubei Province 430000,China)

机构地区：[1]武汉科技大学附属天佑医院医学影像科,湖北武汉430000 [2]武汉大学人民医院放射介入科

出　　处：《介入放射学杂志》2024年第9期1000-1005,共6页Journal of Interventional Radiology

摘　　要：目的 探讨复杂脾动脉瘤(complicated splenic artery aneurysms, CSAA)的腔内介入治疗方法及临床疗效。方法 收集2013年1月至2022年12月本中心收治的15例CSAA患者的临床资料,其表现为破裂出血(n=2)、脾动脉瘤起源于正常脾动脉近端(n=3)、脾动脉瘤起源于肠系膜上动脉-脾动脉共干(n=4)、脾动脉瘤起源于腹腔干-肠系膜上动脉共干(n=6)。根据脾动脉瘤起源及瘤腔大小不同,腔内介入治疗包括:(1)单纯瘤腔内弹簧圈栓塞;(2)流出道、瘤腔及流入道联合栓塞;(3)覆膜支架置入腔内隔绝;(4)裸支架辅助联合弹簧圈栓塞等技术及多种方法联合治疗,并分析腔内介入治疗后中远期疗效。结果 15例CSAA患者共计15枚瘤体,瘤体直径1.8~3.2 cm(2.5±0.4 cm),腔内治疗手术成功率100%,随访时间(22.8±10.2)个月,13例患者(86.7%)术后脾动脉瘤血栓形成且瘤腔无增大,1例患者因瘤腔持续增大再次行腔内介入治疗,1例患者术后未规律服药导致覆膜支架闭塞,随访期间并未出现肝脏及小肠缺血坏死,5例患者出现无症状局灶性脾梗死。结论 对于不同解剖变异起源的脾动脉瘤,腔内介入治疗是可行、安全有效的治疗方法。Objective To discuss the endovascular interventional treatment of complicated splenic artery aneurysms(CSAA)and its clinical efficacy.Methods The clinical data of 15 patients with CSAA,who were admitted to authors′hospital to receive treatment between January 2013 and December 2022,were collected.The clinical manifestations included rupture with bleeding(n=2),splenic aneurysm originating at the proximal end of the normal splenic artery(n=3),splenic aneurysm originating from the superior mesenteric artery-splenic artery co-trunk(n=4),and splenic aneurysm originating from the celiac trunk-superior mesenteric artery co-trunk(n=6).According to the origin of the splenic aneurysm and the size of aneurysmal cavity,the following endovascular treatment methods were employed:(1)coil embolization of aneurysmal cavity,(2)combination embolization of the outflow tract,aneurysmal cavity and inflow tract,(3)covered stent implantation for intraluminal isolation,and(4)bare stent-assisted spring coil embolization and combination therapy with multiple approaches.The medium-term and long-term efficacy of endovascular interventional treatment were analyzed.Results A total of 15 aneurysms were detected in the 15 CSAA patients,the mean diameter of aneurysmal cavity was 1.8-3.2 cm(2.5±0.4 cm),and the success rate of endovascular treatment was 100%.The mean follow-up period was(22.8±10.2)months.In 13 patients(86.7%)the splenic artery aneurysm remained thrombosis with no enlargement of the aneurysmal cavity.One patient had to receive endovascular interventional treatment as the aneurysmal cavity continued to enlarge.One patient developed covered stent occlusion as the patient did not take drugs regularly,and no hepatic or intestinal ischemia,or death occurred during the follow-up period.Asymptomatic focal splenic infarction occurred in 5 patients.Conclusion For CSAA with different anatomical variation origin,endovascular interventional treatment is clinically feasible,safe and effective.

关 键 词：脾动脉瘤 腔内介入 变异脾动脉 破裂 

分 类 号：R739.9[医药卫生—肿瘤]