腹腔動脈瘤に急性大動脈解離を発症した1例  [in Japanese] A Case of Celiac Artery Aneurysm with Type IIIb Aortic Dissection  [in Japanese]

腹腔動脈瘤は希な疾患であるが,破裂した後の手術では高率に死亡する.したがって破裂前に発見した場合は,無症状であっても手術による治療が必要である.今回われわれは腹腔動脈瘤に急性大動脈解離を発症した1例を経験したので報告する.症例は60歳男性.人間ドックで偶然腹腔動脈瘤を指摘され当院紹介となった.精査にてIIIB型大動脈解離を合併した腹腔動脈瘤(最大径3cm)と診断し手術を行った.術中所見では腹腔動脈瘤は大動脈分岐起始部から瘤状に変化しこれに連なる脾動脈瘤も存在した.腹腔動脈瘤を試験的に遮断すると固有肝動脈の拍動は良好であったため,血行再建は不要と判断し動脈瘤の切除のみ施行した.術後一過性に肝機能障害を認めたがそれ以外に合併症もなく術後第24病目に退院となった.本症例のように,上腸間膜動脈を経由した肝への血流が十分保たれていれば腹腔動脈の血行再建は必ずしも必要ではないと思われた.

Celiac artery aneurysm (CAA) is very rare. We report a case of CAA with type IIIb aortic dissection (DA) which was treated surgically. A 60-year-old man who had an abnormal enlargement of the aorta on abdominal ultrasonography was admitted to our hospital. Angiography and CT scan revealed CAA with type IIIb DA. His general condition was stable and surgery was performed electively. The CAA was exposed through a median laparotomy. It was found to be about 3 cm in diameter. As vascular reconstruction seemed difficult and the proper hepatic artery showed good pulsation after clamping the common hepatic artery, we decided to perform celiac artery aneurysmectomy without vascular reconstruction. Except for transient liver dysfunction, there was no other complication and he was discharged on the 24th postoperative day. During surgery for CAA, when collateral perfusion from the SMA to the liver is adequate, it seems that vascular reconstruction is not always necessary as shown by this case.