探讨直径>5 cm的真性巨大脾动脉瘤的临床诊治特点。

回顾性分析2013年5月至2019年11月收治的3例直径>5 cm的真性巨大脾动脉瘤患者的临床资料，并回顾相关文献。

男性1例，女性2例，平均年龄60岁。腹痛、腹胀表现1例，左上腹部搏动性包块1例，查体发现1例；2例合并门脉高压症，女性患者均有2次妊娠史，1例左上腹触及搏动性包块，3例患者均行腹部强化CT检查。1例行介入支架腔内隔绝＋瘤腔弹簧圈栓塞术；1例行开腹脾动脉瘤切除＋脾切除术，术中出血少，未输血；1例行开腹脾动脉瘤切除＋脾切除＋脾静脉瘤切除＋胆囊切除术，术中出血约400 ml，输注红细胞6 U，血浆600 ml。3例均治疗成功，无围术期死亡发生。介入治疗者随访2年3个月，无不适。手术者1例随访6年，预后较好，另1例失访。

直径>5 cm的真性巨大脾动脉瘤罕见，具有独特的临床特征，手术切除仍是其主要且有效的治疗方法，预后较好。

To explore the clinical features of the diagnosis and treatment of true giant splenic artery aneurysm with a diameter of >5 cm.

From May 2013 to November 2019, clinical data of 3 patients with true giant splenic aneurysms with a diameter of > 5 cm, were analyzed retrospectively, meanwhile the relevant literature were also reviewed.

There were 1 male and 2 female patients, with an average age of 60 years. There were 1 case of abdominal pain and distension, 1 case of pulsatile mass in the left upper abdomen and 1 case diagnosed by physical examination, including 2 cases combined with portal hypertension. All of 2 female patients had a history of two pregnancies, including one case of a pulsatile palpable in the left upper abdomen. Three patients received enhanced CT examination of the abdomen. One patient underwent interventional stent endovascular exclusion+ tumor cavity coil embolization. One patient underwent open splenic aneurysm resection+ splenectomy with less intraoperative bleeding and no blood transfusion. One patient underwent open splenic aneurysm resection+ splenectomy+ splenic vein aneurysm resection+ cholecystectomy with intraoperative bleeding of 400 mL and a transfusion of 6 U of red blood cells+ 600 mL of plasma. All 3 cases were successfully treated and no perioperative death occurred. The patient underwent interventional treatment was followed up for 2 years and 3 months without discomfort. One patient who underwent surgery was followed up for 6 years with a good prognosis, and the other was lost to follow-up.

True giant splenic aneurysms with a diameter of > 5 cm is rare and has unique clinical features. Surgical resection remains its main and effective treatment with a better prognosis.