Countryman D, Norwood S, Register D, Torma M, Andrassy R
Am Surg. 1983 Jan;49(1):51-4.
Hepatic artery aneurysms are relatively infrequent lesions and may represent significant problems in both diagnosis and management. Indeed, as many as 30 to 50 per cent of cases are completely unsuspected and are discovered only at autopsy. A case of a very large hepatic artery aneurysm (greatest dimension of approximately 35 centimeters) presenting as an asymptomatic epigastric mass is reviewed, with emphasis on preoperative evaluation and operative technique. Selective arteriography was the cornerstone of diagnosis with other investigative modes proving not to be effective. Surgical therapy included obtaining proximal and distal control, meticulous ligation of the numerous feeding vessels, and finally evacuation and partial excision of the aneurysm sac with careful suture ligation obliteration of the orifice of each feeding vessel. Restoration of hepatic artery flow was not attempted and no compromise in liver function was seen in the postoperative period. The literature on hepatic artery aneurysms is reviewed to include typical presentation, diagnostic methods, surgical approach, and common complications. Only through a high index of suspicion and early angiography can this frequently fatal lesion be detected early in its course and subsequently be subjected to successful surgical management.
肝动脉瘤是相对罕见的病变，在诊断和治疗方面都可能是重大问题。事实上，多达30%至50%的病例完全未被怀疑，仅在尸检时才被发现。本文回顾了一例以无症状上腹部肿块形式出现的巨大肝动脉瘤（最大直径约35厘米）的病例，重点关注术前评估和手术技术。选择性动脉造影是诊断的基石，其他检查方式被证明无效。手术治疗包括获得近端和远端控制，细致结扎众多供血血管，最后排空并部分切除动脉瘤囊，仔细缝合结扎每个供血血管的开口。未尝试恢复肝动脉血流，术后肝功能未见损害。本文回顾了肝动脉瘤的相关文献，包括典型表现、诊断方法、手术入路和常见并发症。只有通过高度的怀疑指数和早期血管造影，才能在这个常致命的病变病程早期将其检测出来，并随后进行成功的手术治疗。
