目的:脾动脉瘤(SAA)在妊娠破裂时与显著的母儿死亡率相关。然而,对于破裂和无症状SAA的最佳产科治疗尚无共识.我们的目标是评估风险因素,介绍,调查,妊娠和产褥期SAA的管理。
方法:MEDLINE,EMBASE,和Scopus从2000年1月至2020年10月使用与怀孕和SAA相关的关键词进行筛查。考虑了妊娠至产后6周的破裂和未破裂SAA的文章。数据由两名独立的审阅者提取。采用定量分析和叙事综合。
结果:包括75例破裂和9例未破裂的SAA。平均年龄为31.1±5.2岁,其中47例(64.4%)为经产,46例(54.8%)为妊娠晚期,主要伴有上腹部和左侧腹痛。11例(14.7%)出现迟发性失血和症状双重破裂现象;60例(70.7%)接受术前影像学检查。平均SAA大小为23.0±13.6mm。破裂的SAA主要通过剖腹手术(61,81.3%)进行治疗,通常伴有脾切除术。栓塞或剖腹手术未破裂的SAA。未破裂的SAA没有死亡,但破裂时死亡率显著(19,25.7%产妇;36,50.0%胎儿)。
结论:考虑到他们的易感性和妊娠死亡率高,及时诊断和管理SAAs至关重要,需要提高产科医生的意识。
OBJECTIVE: Splenic artery aneurysms (SAA) are associated with significant maternal and fetal mortality when ruptured in pregnancy. However, there is no consensus on the optimal obstetric management of both ruptured and asymptomatic SAA. We aimed to evaluate risk factors, presentation, investigation, and management of SAA in pregnancy and puerperium.
METHODS: MEDLINE, EMBASE, and Scopus were screened from January 2000 to October 2020 using keywords related to pregnancy and SAA. Articles on ruptured and unruptured SAA in pregnancy until 6 weeks postpartum were considered. Data were extracted by two independent reviewers. Quantitative analysis and narrative synthesis were used.
RESULTS: Seventy-five ruptured and nine unruptured SAA cases were included. Mean age was 31.1 ± 5.2 years, of which 47 (64.4%) were multiparous and 46 (54.8%) presented in their third trimester, largely with epigastric and left-sided abdominal pain. The double-rupture phenomenon of delayed blood loss and symptoms was noted in 11 (14.7%); 60 (70.7%) underwent preoperative imaging. Mean SAA size was 23.0 ± 13.6 mm. Ruptured SAA were primarily managed by laparotomy (61, 81.3%) typically with splenectomy, and unruptured SAA by embolization or laparotomy. There was no mortality in unruptured SAA, but significant mortality on rupture (19, 25.7% maternal; 36, 50.0% fetal).
CONCLUSIONS: Given their predisposition and high mortality in pregnancy, it is crucial that SAAs are promptly diagnosed and managed, requiring increased obstetrician awareness.