Kadoya Masatoshi, Kondo Satoshi, Hirano Satoshi, Ambo Yoshiyasu, Tanaka Eiichi, Takemoto Norihiro, Morikawa Toshiaki, Okushiba Shunichi, Katoh Hiroyuki
Department of Surgical Oncology, Hokkaido University Graduate School of Medicine Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
Hepatogastroenterology. 2007 Jun;54(76):1259-61.
We report a case of multiple sequential celiacsplenic aneurysms which we removed completely without arterial reconstruction. The patient was a 67-year-old man. During work-up for hypertension and diabetes, a splenic artery aneurysm was identified on abdominal ultrasonography. Follow-up examination 1 year and 3 months later showed enlargement of the aneurysm. The patient was referred to our Radiology Department for treatment. Abdominal computed tomography and angiography of the celiac trunk showed that the celiac artery was narrowed and then dilated to form a fusiform aneurysm. Splenic artery aneurysms were identified immediately distal to the bifurcation with the common hepatic artery, measuring about 5 cm and 3 cm. These findings ruled out treatment by interventional radiology, and surgery was performed. At laparotomy, a white, 5-cm aneurysm was densely adherent to the pancreas, and separation was impossible. We performed en bloc resection of the pancreatic body and tail, spleen, celiac artery, and common hepatic artery. Since pulsation in the replaced right hepatic artery and the color of the stomach were good, we did not perform an arterial reconstruction. Although the surgical treatment of aneurysms generally consists of resection and arterial reconstruction, we resected the lesion safely and completely without arterial reconstruction.
我们报告一例多发连续性腹腔干脾动脉瘤病例，我们对其进行了完整切除且未进行动脉重建。患者为一名67岁男性。在对高血压和糖尿病进行检查期间，腹部超声检查发现了脾动脉瘤。1年零3个月后的随访检查显示动脉瘤增大。该患者被转诊至我们放射科进行治疗。腹腔干的腹部计算机断层扫描和血管造影显示腹腔干变窄，随后扩张形成梭形动脉瘤。在与肝总动脉分叉处的远侧立即发现了脾动脉瘤，大小约为5厘米和3厘米。这些发现排除了介入放射学治疗的可能性，遂进行了手术。在剖腹手术中，一个5厘米的白色动脉瘤与胰腺紧密粘连，无法分离。我们对胰体尾、脾脏、腹腔干和肝总动脉进行了整块切除。由于替代的右肝动脉搏动良好且胃的颜色正常，我们未进行动脉重建。尽管动脉瘤的外科治疗通常包括切除和动脉重建，但我们在未进行动脉重建的情况下安全、完整地切除了病变。
