CAJ | 학술논문

目的：探讨肝炎后肝硬化性脾动脉瘤的CT征象与手术方式选择的关系。方法回顾性分析61例肝硬化门脉高压性脾动脉瘤的CT表现(部位、数量、大小、门静脉改变、曲张静脉团、门体分流血管网和脾脏改变)、临床特征和手术方式，并进行统计。结果4例主瘤体位于脾动脉远端、直径1.0~2.0 cm、存在脾肾分流和脾大的患者行主瘤体旷置术+分支小动脉瘤分期栓塞。瘤体切除+脾脏切除+曲张血管团离断术15例中，主瘤体位于脾动脉中段4例和脾动脉远端11例，主瘤体直径大于2.0cm的15例和1.0~2.0 cm的13例，门静脉海绵样变4例、脾胃静脉曲张5例，食管胃底静脉曲张15例，脾胃肾静脉分流4例，巨脾15例和脾梗死4例。瘤体切除+分支小动脉瘤分期栓塞7例，主瘤体位于脾动脉近段7例，主瘤体直径1.0~2.0 cm 7例，食管胃底静脉曲张2例，脾大7例。4例单发、瘤体直径1.0~2.0 cm、脾大患者行瘤体切除+重建脾动脉连续性，其中脾动脉近端1例、中段2例和远端1例。结论可根据脾动脉瘤的部位、数量、大小、门静脉改变、曲张静脉团、门体分流血管网和脾脏改变结合患者年龄、性别、体重指数及病史选择手术方法。
목적：탐토간염후간경화성비동맥류적CT정상여수술방식선택적관계。방법회고성분석61례간경화문맥고압성비동맥류적CT표현(부위、수량、대소、문정맥개변、곡장정맥단、문체분류혈관망화비장개변)、림상특정화수술방식，병진행통계。결과4례주류체위우비동맥원단、직경1.0~2.0 cm、존재비신분류화비대적환자행주류체광치술+분지소동맥류분기전새。류체절제+비장절제+곡장혈관단리단술15례중，주류체위우비동맥중단4례화비동맥원단11례，주류체직경대우2.0cm적15례화1.0~2.0 cm적13례，문정맥해면양변4례、비위정맥곡장5례，식관위저정맥곡장15례，비위신정맥분류4례，거비15례화비경사4례。류체절제+분지소동맥류분기전새7례，주류체위우비동맥근단7례，주류체직경1.0~2.0 cm 7례，식관위저정맥곡장2례，비대7례。4례단발、류체직경1.0~2.0 cm、비대환자행류체절제+중건비동맥련속성，기중비동맥근단1례、중단2례화원단1례。결론가근거비동맥류적부위、수량、대소、문정맥개변、곡장정맥단、문체분류혈관망화비장개변결합환자년령、성별、체중지수급병사선택수술방법。
Objective To evaluate how to select operation procedures for different CT manifestation of splenic artery aneurysm ( SAA) with posthepatitic cirrhosis. Methods In 61 cases with SAA,the CT manifestation ( location,number,size,portal vein,varicose vein,proxi-mal splenorenal shunt and spleen changes) of SAA,clinical features of cases,and operation approach were were retrospectively analyzed. Re-sults 4 patients who have the primary tumors located in the distal splenic artery with diameter 1. 0~2. 0 cm,spleen kidney shunt and mega-losplenia were given aortic aneurysm exclusion and branch aneurysms embolism by stages. Amiong the 15 cases of tumors resection,splenecto-my and devascularization,there were 4 cases of the primary tumors located in the middle of splenic artery and 11 cases in the distal splenic artery. There were 15 cases whose diameter of the primary tumor were lager than 2. 0 cm and 13 cases whose diameter of the primary tumor were 1. 0~2. 0 cm. There were 4 cases of cavernous transformation of portal vein,5 cases of splenic and gastric varices,15 cases of esophage-al and gastric varices,4 cases of splenic and gastric venous shunt,15 cases of megalosplenia and 4 cases of splenic infarction. Tumors resec-tion and branch aneurysms embolism by stages were conducted in 7 cases. The primary tumors located in the proximal splenic artery occured in 7cases,and the diameter of the primary tumor were 1. 0~2. 0 cm occured in 7 cases. Esophageal and gastric varices occured in 2 cases and splenomegaly occured in 7 cases. And there were 4 cases whose diameter of the tumor were 1. 0~2. 0 cm were given tumor resection and re-construction of splenic artery and continuity, including 1 case of proximal splenic artery,2 cases of medial splenic artery and 1 case of distal splenic artery. Conclusion Operation procedures were confirmed by CT findings such as location,number,size,portal vein,varicose vein, proximal splenorenal shunt and spleen changes of SAA combined with age,gender,body mass index and history.