急性肠系膜上动脉缺血的支架置入与药物溶栓近、中期疗效分析  

Acute superior mesenteric ischemia： a contrast syudy on short-and mid-term result between stent implantation and pharmaceutical thrombolysis

作　　者：张曦彤[1] 张洪义[1] 张伟[1] 洪铎[1] 安建立[1] 夏永辉[1] 徐克[1] 

机构地区：[1]中国医科大学附属第一医院介入科,沈阳 110001

出　　处：《中华医学杂志》2011年第7期473-476,共4页National Medical Journal of China

基　　金：国家“十一五”科技支撑计划课题（2007BAl05804）

摘　　要：目的比较支架置入与药物溶栓治疗急性肠系膜卜动脉缺血的近、中期疗效。方法收集2004年1月至2008年12月，中国医科大学附属第一医院因肠系膜上动脉狭窄或闭塞引起急性肠缺血住院患者35例。其中，支架置入12例（介入治疗组），外周药物溶栓23例（药物溶栓组）。介入治疗组采用球囊扩张及支架置人并辅以抗凝、祛聚及扩血管治疗，药物溶栓组采川尿激酶配合抗凝、祛聚及扩血管治疗。两组患者出院后均口服氯吡格雷及阿司匹林并进行随访。用Fisher确切概率法比较分析两组疗效差异的显著性。结果 药物溶栓组临床有效7例，无效16例（加重或死亡7例，治疗失败行部分肠切除9例）。介入治疗组10例置入支架（1例术后第3灭死于急性心肌梗死亡），2例开通失败。随访1～48（15±12）个月。药物溶栓组1例病情平稳，6例死于再发急性肠系膜动脉栓塞；支架置入组7例病情平稳，1例术后20个月死于急性心肌梗死（无肠缺血症状），l例术后28个月再发肠缺血，经肠系膜动脉置管溶栓后症状消失。结论支架置入在改善肠系膜上动脉闭寒引起肠缺血及提高患者生存率方面均显著优于药物保守治疗，为尚未出现肠坏死患者的治疗方案的选择提供了可靠依据。Objective To compare the short-term and medium-term result of stent implantation with pharmaceutical thrombolysis in patients with acute superior mesenteric artery occlusion. Methods From January, 2004 to December, 2008, thirty-five patients diagnosed acute superior mesenterie ischemia, 12 patients treated with stent implantation （interventionat therapy group） and 23 patients with pharmaceutical thrombolysis（thrombolytic therapy group）. Interventional therapy group treated with balloon dilatation and stent implantation assisted with antieoagulation, antiplatelet and vascular dilation agents. Thrombolytic therapy group used urokinase combined with anticoagulation, antiplatelet and vascular dilation agents. All patients had tsken elopidogrel and aspirin orally after discharged and followed up. The clinical effects of both groups were evaluated separately and the Fisher exact test was used to analysis the significant differences. Results In the 23 cases of thrombolytic therapy group, 7 cases was effective, 16 cases was ineffective（7 cases aggravated or died, 9 cases turn to surgical operation）. In the 12 cases of interventional therapy group, 10 cases treated with stent implantation（ 1 case died of acute cardiac infarction 3 days after interventional operation）, 2 cases failed in racanalizing. All patients were followed up after discharged （range 1 -48 months, mean 15 ±12 months） , 1 case in thrombolytic therapy group was stable, 6 cases died of the recurrence of acute superior mesenteric artery occlusion; 7 cases in interventiona] therapy group was stable, 1 case died of acute cardiac infarction 20 months after interventional operation （intestinal ischemia not appeared）, 1 case had intestinal ischemia reoccmxed and recovered by superior mesenteric artery thrombolysis. Conclusions In the treatment of acute superior mesenteric isehemia, stent implantation was obviously superior to pharmaceutical thrombolysis in improving intestinal ischemia and survival, therefore itcould provided a reliable

关 键 词：急性肠系膜上动脉闭塞 支架 溶栓 

分 类 号：R657.2[医药卫生—外科学]