中国实用外科杂志

中国实用外科杂志

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肠系膜上动脉瘤17例诊治分析

冯桂林1，周    旻2，林    越2，司    逸2，唐    骁2，王利新2，史振宇2，郭大乔2   

  1. 1皖南医学院第一附属医院（皖南医学院弋矶山医院）血管外科，安徽芜湖241001；2复旦大学附属中山医院血管外科，上海200032
  • 出版日期:2021-02-01 发布日期:2021-02-05

  • Online:2021-02-01 Published:2021-02-05

摘要： 目的    探讨肠系膜上动脉瘤（SMAA）的病因、诊断和治疗方式的选择。方法    回顾性分析2010年1月至2018年12月复旦大学附属中山医院血管外科收治的17例SMAA病人临床资料。观察指标包括院内死亡、围手术期并发症及疾病相关病死率和手术相关并发症。结果    17例病人中，6例接受了开放手术，开放手术技术成功率100%。11例接受腔内治疗，腔内治疗技术成功率90.9%。病人中位住院时间12（4~71）d，无院内死亡。1例开放手术病人因术中切除部分胰腺组织，术后出现胰漏；1例腔内治疗病人术中造影存在少量内漏，后随访消失。17例病人均接受随访，中位随访时间48（12~108）个月。1例病人术后发现瘤体增大，再次收入院造影显示为Ⅱ型内漏。1例腹腔多发动脉瘤病人术后64个月出现左肾血肿，肾动脉瘤破裂，急诊行动脉瘤栓塞术。随访过程中，无SMAA相关性死亡发生。结论    SMAA罕见，一旦破裂死亡风险较高。术前应进行详细的CT血管造影评估，开放手术和腔内治疗对SMAA均安全、有效，需根据病人情况个体化选择。

关键词: 肠系膜上动脉瘤, 胰十二指肠下动脉瘤, 开放手术, 腔内治疗

Abstract: Superior mesenteric artery aneurysm: An analysis of diagnosis and treatment of 17 cases        FENG Gui-lin*, ZHOU Min, LIN Yue, et al. *Department of Vascular Surgery, the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu 241001, China
Corresponding author: SHI Zhen-yu, E-mail：shizhenyumax@163.com
Abstract    Objective    To investigate the etiology, diagnosis and treatment strategy in patients with superior mesenteric artery aneurysm (SMAA). Methods    From January 2010 to December 2018, 17 patients with SMAA underwent treatment in the Department of Vascular Surgery，Zhongshan Hospital of Fudan University. The clinical data were collected and reviewed. Early outcomes included in-hospital death and perioperative morbidity. Long-term outcomes contained SMAA-related mortality and operation-related complications. Results    Of 17 patients, 6 patients underwent open surgery, and 11 patients received endovascular treatment. The technique success rate of open surgery and endovascular therapy was 100% and 90.9%, respectively. The median hospital stay was 12 days (4—71 days). In-hospital death was not observed in the patients, only 1 patient suffered from pancreatic leakage due to partial pancreatectomy. Slight immediate endoleak was detected on intraoperative angiography in 1 patient, and sealed spontaneously during follow up. The median follow-up time of 17 patients was 48 months (12—108 months). During the follow-up, 1 patient was found with expanded SMAA due to type Ⅱ endoleak; 1 patient was detected with left renal hematoma and ruptured renal artery aneurysm, who received coil embolization of the sac and inflow artery at emergent settings. SMAA-related death was not observed in the patients. Conclusion    SMAAs are rare, but appear to have a high risk of death once ruptured. Preoperative CT angiography is essential for the patients. Both of open surgery and endovascular treatment are effective and safe in the treatment of SMAA. Individualized therapy should be considered according to the patient’s anatomical characteristics.

Key words: superior mesenteric artery aneurysm, pancreaticoduodenal artery aneurysm, open surgery, endovascular treatment