肠系膜动脉瘤破裂出血的诊治分析:附8例报告
作者:
作者单位:

湖南省郴州市第一人民医院 血管外科,湖南 郴州 423000

作者简介:

徐韶飞,湖南省郴州市第一人民医院主治医师,主要从事血管外科临床和基础方面的研究。

通信作者:

余永忠, Email: yuyongzhong7290@163.com

基金项目:


Diagnosis and treatment of ruptured mesenteric artery aneurysm: a report of 8 cases
Author:
Affiliation:

Department of Vascular Surgery, Chenzhou First People's Hospital, Chenzhou, Hunan 423000, China

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    摘要:

    背景与目的 肠系膜动脉瘤是一种罕见的疾病,大部分患者确诊时动脉瘤已出现破裂大出血,病情危重,治疗风险大。本文回顾性分析肠系膜动脉瘤破裂患者的病例特点,探讨该疾病诊断和治疗方式的选择。方法 回顾性分析于2016年1月—2020年12月在湖南省郴州市第一人民医院血管外科收治的8例肠系膜动脉瘤破裂出血患者的临床资料和随访情况。结果 8例患者行腹部CTA或腹部增强CT明确诊断为肠系膜动脉瘤破裂出血。患者均行急诊手术治疗,其中6例行腹腔动脉造影+栓塞术;1例因腔内治疗失败后选择行开放手术;1例首选开放手术。8例患者均抢救成功,3例患者腔内治疗术后出现腹痛腹胀,药物保守治疗好转;1例患者开放手术术后出现创伤性胰腺炎,予以药物治疗治愈。所有患者住院期间均无再出血、肠缺血、肠坏死等并发症与再次手术。8例患者均随访12个月,患者正常饮食后无腹痛腹胀不适,无再次出血;复查腹部增强CT或CTA提示动脉瘤栓塞良好,血肿明显吸收。结论 临床医生要提高对肠系膜动脉瘤破裂出血疾病的认识和警惕,及时做出正确诊断。手术治疗方案可分为开放手术和腔内治疗,均安全和有效,术前应根据患者病情、瘤体位置和形态决定具体手术方案。

    Abstract:

    Background and Aims Mesenteric artery aneurysm is a rare type of visceral aneurysm, and most patients are diagnosed due to rupture and hemorrhage of the aneurysm, which is a critical condition with high treatment-related risk. Therefore, this study was conducted to investigate the diagnosis and treatment strategy of this disease through a retrospective analysis of the clinical characteristics of patients with ruptured mesenteric artery aneurysm.Methods The clinical data and follow-up results of 8 patients with ruptured mesenteric artery aneurysm treated in the Department of Vascular Surgery of Chenzhou First People's Hospital during January 2016 to December 2020 were retrospectively analyzed.Results In all the 8 patients, definitive diagnosis of ruptured mesenteric artery aneurysm was made by abdominal CTA or enhanced CT scanning. All patients received emergency surgical treatment, of whom, 6 cases underwent coeliac arteriography and aneurysm embolization, 1 case underwent open surgery due to endovascular treatment failure, and 1 case underwent open surgery directly. All the 8 patients were successfully salvaged. Three patients developed abdominal bloating and pain after endovascular treatment, and was resolved after medical treatment, 1 case developed traumatic pancreatitis after open surgery, and was cured and discharged after medical treatment. There were no complications such as rebleeding, intestinal ischemia, and intestinal necrosis, or requirement for reoperation in all patients during hospital stay. All the 8 patients were followed-up for 12 months, abdominal pain or abdominal distension after regular diets as well as rebleeding occurred in none of them, and reexamination of abdominal CT showed the aneurysms were embolized completely, and the abdominal hematoma was obviously absorbed.Conclusion Clinicians should increase their understanding and awareness of ruptured mesenteric artery aneurysm, so as to and make a timely and correct diagnosis. Both open surgery and endovascular treatment are effective and safe in the treatment of ruptured mesenteric artery aneurysm. The selection of surgical procedures should be determined based on patient's condition as well as the shape and position of the aneurysm.

    表 1 8例患者的临床资料Table 1 Clinical Data of the 8 patients
    图1 部分患者CT资料(红色箭头表示肠系膜动脉瘤的位置) A-C:腹部增强CT,可见动脉瘤和腹腔大血肿;D-F:腹部CTA,可见肠系膜动脉瘤Fig.1 CT data of some patients (the red arrows showing the locations of the mesenteric aneurysm) A-C: Enhanced CT scanning showing mesenteric aneurysm and large retroperitoneal hematoma; D-F: Abdominal CTA showing the mesenteric aneurysm
    图2 部分患者术中资料 A-E:腹腔动脉造影见肠系膜动脉瘤显影,黄色箭头显示动脉瘤位置;F-J:使用弹簧圈栓塞动脉瘤和瘤体近端和远端动脉后动脉瘤未显影,红色箭头表示动脉瘤成功被栓塞Fig.2 Intraoperative views in some patients A-E: Celiac arteriography showing the mesenteric aneurysm, and the yellow arrow indicating the position of the aneurysm; F-J: No contrast filling in the aneurysm after embolization of the inflow and outflow arteries of the aneurysm with spring coil, and the red arrow indicating the successful embolization of the aneurysm
    图3 部分患者术后复查腹主动脉CTA资料(未见动脉瘤显影,动脉瘤栓塞良好)Fig.3 Abdominal CTA data of some patients after operation (no contrast filling of the aneurysm and complete embolization of the aneurysm)
    图1 部分患者CT资料(红色箭头表示肠系膜动脉瘤的位置) A-C:腹部增强CT,可见动脉瘤和腹腔大血肿;D-F:腹部CTA,可见肠系膜动脉瘤Fig.1 CT data of some patients (the red arrows showing the locations of the mesenteric aneurysm) A-C: Enhanced CT scanning showing mesenteric aneurysm and large retroperitoneal hematoma; D-F: Abdominal CTA showing the mesenteric aneurysm
    图2 部分患者术中资料 A-E:腹腔动脉造影见肠系膜动脉瘤显影,黄色箭头显示动脉瘤位置;F-J:使用弹簧圈栓塞动脉瘤和瘤体近端和远端动脉后动脉瘤未显影,红色箭头表示动脉瘤成功被栓塞Fig.2 Intraoperative views in some patients A-E: Celiac arteriography showing the mesenteric aneurysm, and the yellow arrow indicating the position of the aneurysm; F-J: No contrast filling in the aneurysm after embolization of the inflow and outflow arteries of the aneurysm with spring coil, and the red arrow indicating the successful embolization of the aneurysm
    图3 部分患者术后复查腹主动脉CTA资料(未见动脉瘤显影,动脉瘤栓塞良好)Fig.3 Abdominal CTA data of some patients after operation (no contrast filling of the aneurysm and complete embolization of the aneurysm)
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徐韶飞,郑翼德,樊孝文,卢勇,余永忠.肠系膜动脉瘤破裂出血的诊治分析:附8例报告[J].中国普通外科杂志,2022,31(6):792-798.
DOI:10.7659/j. issn.1005-6947.2022.06.012

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  • 收稿日期:2021-08-04
  • 最后修改日期:2021-12-20
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  • 在线发布日期: 2022-07-11