Clinical Experiences of Splenic Artery Aneurysm

脾動脈瘤之臨床經驗

楊宜寰(Yi-Hwan Yang) ； 陳梭嘉(Chun-Chia Chen) ； 王聖賢(Sun-Sang Wang) ； 譚振晃(Tseng-Nip Tam) ； 張扶陽(Full-Young Chang)

《中華民國消化系醫學雜誌》 15卷4期 (1998/12) Pp. 231-239

https://doi.org/10.6557/GJTb.199812_15(4).0002

摘要

脾動脈瘤的發生率佔腹腔內血管瘤的第三位，它的重要性在於產生破裂時有極高的死亡率。本研究回顧分析1985至1998年間九位被診斷有脾動脈瘤之病人的臨床資料，其中有七位男性及兩位女性，年齡分佈於31歲至85歲之間（平均58.8歲）。三位病人以腹部急症與休克為初步表現者被證實有脾動脈瘤破裂；另外三位病人有非特異性的上腹部或左上腹部疼痛或不適；三位病人先於腹部X光發現有左上腹部鈣化，有五位病人先於腹部超音波發檢查現脾動脈附近之囊狀結構，進一步影像學檢查（Doppler超音波、電腦斷層、磁振血管攝影、或腹部血管攝影）才診斷出患有脾動脈瘤。脾動脈瘤之大小介於0.6至13.0公分之間（平均4.2公分），發生破裂之脾動脈瘤的大小則介於2.0至5.0公分之間（平均3.5公分）。脾動脈瘤發生破裂的三位病人全部接受緊急的脾動脈瘤與脾臟切除手術，其中一位術前即有嚴重休克者不幸死亡，另外兩位則康復。未接受手術治療的四位病人於追蹤期間內（15至160個月）沒有發生脾動脈瘤破裂或其它相關併發症。本研究發現脾動脈瘤於臨床上是一個不常見但重要的疾病，其早期診斷有賴臨床醫師與放射科醫師的警覺，適當的治療則須依據每位病人的不同狀況加以選擇，以期減少死亡率與併發症。

關鍵字

脾動脈瘤

並列摘要

Splenic artery aneurysms are the third most common intra-abdominal aneurysms. They are important vascular diseases because rupture of the splenic artery aneurysms is a clinical emergency and results in catastrophic hemorrhage and high mortality rate. The records of patients with documented splenic artery aneurysms diagnosed between 1985 and 1998 were reviewed. Seven were men and 2 women. Ages ranged from 31 to 85 years (mean 58.8 years). Three patients presenting with acute abdomen and shock were proved to have ruptured splenic artery aneurysms. Another 3 patients had nonspecific epigastric or left upper quadrant abdominal discomfort. Splenic artery aneurysms were impressed by a ring calcification on plain abdominal radiograph in 3 patients and by a cystic lesion on ultrasonogram in 5 patients. Further imaging studies including Doppler ultrasonography, contrast-enhanced abdominal computed tomography, magnetic resonance angiography, and celiac angiography may be required to confirm the diagnosis. The diameter of the aneurysms ranged from 0.6 to 13 cm (mean 4.2 cm). The size of the ruptured aneurysms ranged from 2 to 5 cm (mean 3.5 cm). All of the splenic artery aneurysms located at the distal third of the splenic artery. Three patients with ruptured splenic artery aneurysms had emergent surgery. Splenectomy and aneurysmectomy were performed in these patients. Profound shock resulted in one mortality. Another two patients receiving elective surgery had uneventful course. No rupture or other complications of the aneurysms occurred in the four patients not undergoing surgery in the period of follow-up (15-160 months). This study demonstrated that splenic artery aneurysm is an uncommon, but clinically important disease. It requires alertness of physicians and radiologists to make a diagnosis. Appropriate management must be applied according to the individualized conditions of the patients.

並列關鍵字

splenic artery aneurysm