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腹腔镜下脾动脉远端动脉瘤切除术并端端吻合术治疗脾动脉远端动脉瘤:一例报告

Treatment of distal splenic artery aneurysm by laparoscopic aneurysmectomy with end-to-end anastomosis: A case report.

作者信息

Zhang Yuhua, Liu Zhenjie, Shen Guoliang, Zhang Jungang, Assa Carmel Rebecca, Hong Defei

机构信息

Division of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China University of Wisconsin School of Medicine and Public Health, WI.

出版信息

Medicine (Baltimore). 2017 May;96(19):e6260. doi: 10.1097/MD.0000000000006260.

Abstract

RATIONALE

Splenic artery aneurysm (SAA) is the most common visceral artery aneurysm, while most SAAs are treated by endovascular or open procedures.

PATIENT CONCERNS

Here we present a case of SAA treated by laparoscopic aneurysmectomy with end-to-end anastomosis.

DIAGNOSES

A 40-year-old woman was incidentally found to have an asymptomatic distal SAA. CT scan revealed the SAA to be located at the hilum of the spleen, with a maximal diameter of 2.7 cm.

INTERVENTIONS

To prevent sudden rupture, the patient received laparoscopic aneurysmectomy. During the operation, end-to-end anastomosis was also performed since a tortuous proximal splenic artery prevented delivery of the stent graft.

OUTCOMES

The patient was ambulated 12 hours after surgery and discharged 5 days later. Postoperative recovery was smooth without hemorrhage, infarction, infection, or splenic artery thrombosis. At 10-month follow-up,no hemorrhage, aneurysm recurrence, spleen infarction, splenic artery stenosis, or thrombosis had occurred.

LESSONS

Patients with distal SAA can be treated by laparoscopic aneurysmectomy with end-to-end anastomosis to preserve the spleen. The laparoscopic procedure is safe and feasible in the selected patients.

摘要

理论依据

脾动脉瘤(SAA)是最常见的内脏动脉瘤,而大多数SAA通过血管内或开放手术治疗。

患者情况

在此,我们报告一例通过腹腔镜动脉瘤切除术及端端吻合术治疗的SAA病例。

诊断

一名40岁女性偶然发现患有无症状性远端SAA。CT扫描显示SAA位于脾门处,最大直径为2.7厘米。

干预措施

为防止突然破裂,患者接受了腹腔镜动脉瘤切除术。由于脾动脉近端迂曲,无法输送覆膜支架,因此术中还进行了端端吻合术。

结果

患者术后12小时可下床活动,5天后出院。术后恢复顺利,无出血、梗死、感染或脾动脉血栓形成。随访10个月时,未发生出血、动脉瘤复发、脾梗死、脾动脉狭窄或血栓形成。

经验教训

远端SAA患者可通过腹腔镜动脉瘤切除术及端端吻合术治疗以保留脾脏。腹腔镜手术在选定患者中是安全可行的。

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