2015年 · 第53卷第05期

Splenic aneurysms account for about 60% of visceral aneurysms, and the incidence rate is 0.1% ~10.4%. The incidence ratio of male and female is about 1:4^[1,2]。 The incidence of true splenic aneurysm rupture is 3% ~10%, and the mortality rate after rupture is 10% ~25%. The rupture and mortality rate are higher in patients with pregnancy or portal hypertension. In recent years, various endovascular therapies have been gradually used for the treatment of splenic aneurysms^[3,4,5]。 In the past 4 years, 11 patients with splenic artery aneurysm have been treated with embolization. The clinical methods and efficacy are reported as follows.

A 62-year-old male was admitted to the hospital on 27 June 2013 mainly due to "abdominal pain for 12 h with transient syncope for 4 h". The patient experienced dull pain in the lower abdomen without obvious trigger 12 h ago, which persisted, accompanied by soreness and weakness in the waist, no abdominal distension, no nausea and vomiting, no diarrhea and melena, no fear of cold and fever, and was not taken seriously. Four hours ago, he suddenly fainted at home, fell to the ground, accompanied by amaurosis and loss of consciousness, and recovered spontaneously after 1 minute, without headache and limb twitching. At the same time, he felt severe abdominal pain that could not be relieved, radiating to the groin area, accompanied by abdominal distension and sweating profusely. He went to the local hospital and CT scan showed suspicious rupture of abdominal aortic aneurysm, so he was transferred to our hospital. The patient had acute pancreatitis 10 years ago and was cured conservatively. History of hypertension, diabetes and coronary heart disease is denied. No history of hepatitis and tuberculosis. There was no history of surgical trauma. No history of drug food allergies. No smoking history.

Male, 23 years old, was admitted to hospital on February 10, 2014 for body shaping due to large area of skin sagging, folding friction and poor elasticity for 3 years. The patient underwent laparoscopic Roux-en-y gastric bypass (RYGP) bariatric surgery 3 years ago due to obesity, and his body weight decreased from 170 kg to 76 kg, which remained unchanged for 1 year. He has a history of asthma for more than 20 years and has been treated with medication for a long time. Physical examination: Standing position from axillary area to elbow, "sleeve-shaped" upper arm, obvious skin sagging 4~6 cm, breast area skin sagging and sagging, abdominal wall skin sagging and folding about 5 cm, buttocks and thighs skin sagging and wrinkled. Echocardiography: (1) No abnormalities in the intracardiac structure; (2) T1 (light); (3) Left ventricular diastolic function decreased. Electrocardiogram: (1) sinus arrhythmia; (2) Occasional premature atrial contractions. Blood routine: white blood cell count 9.28×10⁹/L, red blood cell count 4.18×10¹²/L, hemoglobin 123 g/L, platelet count 216×10⁹/L. Biochemical routine: K^＋3.58 mmol/L, Na^＋143 mmol/L, Cl^–104 mmol/L, glucose 4.74 mmol/L, urea nitrogen 4.06 mmol/L, total protein 58.7 g/L, albumin 37.2 g/L, albumin/globulin 1.73. Chest X-ray showed no abnormalities. Admission diagnosis: (1) large area skin laxity of the whole body after bariatric surgery; (2) Asthma.

Female, 56 years old. Due to dull pain in the middle abdomen for more than 10 years, the results of outpatient abdominal CT examination indicated that the left abdominal cavity occupied the space and was admitted to our hospital on June 20, 2014. The patient denied a history of nausea and vomiting, jaundice and hyperthermia; History of diarrhea, hematemesis, melena and constipation was denied. There was no history of hepatitis and abdominal trauma, and no history of smoking or drinking. Physical examination: The patient had normal body shape and good general condition. The superficial lymph nodes were not swollen, the skin and sclera were not yellowed, the heart and lungs were not abnormal, the middle abdomen was tender, and there was no rebound pain and muscle tension. Auxiliary examination: blood routine showed white blood cell count 11.88×10⁹/L, red blood cell count 2.98×10¹²/L, hemoglobin 92.00 g/L; Urinary routine showed bacteria 3 939.10/μ L, and no abnormalities were found in stool routine; Ferritin 375.80 g/L, alpha-fetoprotein 1.44 U/ml, CA19-9 0.62 U/ml, no significant abnormalities in liver and kidney function, hepatitis indexes: HBsAg (–), HBsAb (–), HBeAg (–), HBeAb (–), HBcAb (–), anti-HCV (–). Admission diagnosis: Abdominal space occupation. B-ultrasound examination results: abdominal flatulence, some sections were unclear, and a mixed echo light group of about 125 mm ×94 mm in size was seen in the scanned abdominal cavity in the tail area of the pancreas, with clear boundary, mainly hyperechoic inside, and the boundary with the upper pole of the left kidney was unclear. No obvious liquid dark area echoes and dilated intestines were found in the remaining abdominal cavity, suggesting that the tail area of the pancreas was mixed and occupied, and the boundary with the upper pole of the left kidney was unclear. Results of renal phase III enhanced CT examination: changes around the pancreas, pancreatitis to be excluded, occupied space in the left abdominal cavity, considered as hamartoma, may be closely related to the left kidney, perisplenic effusion (Figure 1)。