孤立性腹腔干与肠系膜上动脉夹层二例并文献复习  

The diagnosis and treatment of isolated celiac and superior mesenteric artery dissection：2 cases report and literature review

作　　者：蔡明岳[1] 孟晓春[1] 姜在波[1] 陈俊伟[1] 黄文薮[1] 朱康顺[1] 单鸿[1] 

机构地区：[1]中山大学介入放射学研究所中山大学附属第三医院放射科 ,广州510630

出　　处：《中华内科杂志》2011年第9期743-746,共4页Chinese Journal of Internal Medicine

摘　　要：目的探讨孤立性腹腔干及肠系膜上动脉（SMA）夹层的诊断及治疗方法。方法收集中山大学附属第三医院收治的2例孤立性腹腔干并SMA夹层的临床资料，并结合文献报道的119例病例，对孤立性内脏动脉夹层（IDVA）的诊断及治疗方法进行分析总结。结果119例IDVA中69例存在相关症状，全部病例均由增强CT或MRI检查确诊。发现IDVA后，采取外科治疗8例，支架置入术5例，保守治疗106例，均取得满意疗效。本组2例患者亦由CT检查发现，并经血管造影证实，1例行降压、抗凝治疗，1例行支架置人术，随访中均无不适。结论腹腔增强CT或MRI检查是诊断IDVA的主要方法。大部分IDVA可选择保守治疗，但需密切CT随访病变情况；对于动脉破裂、管腔阻塞及保守治疗中夹层进展者，需行腔内介入治疗或外科手术治疗。Objective To investigate the diagnosis and treatment of isolated celiac artery （CA） dissection and superior mesenteric artery （SMA） dissection. Methods Integrating clinical data of 119 cases with isolated dissection of the visceral arteries （IDVA） reported in literature and 2 patients with spontaneous isolated dissections of both CA and SMA treated in the Third Affiliated Hospital of Sun Yat-sen University, the diagnosis and treatment of IDVA were analyzed retrospectively. Results Among 119 cases reported in the literature, 69 cases were symptomatic. All of the cases were diagnosed by contrast-enhanced abdominal CT or MRI. After IDVA was discovered, surgical treatment and endovascular stent placement was performed in 8 and 5 patients respectively, although the remaining 106 patients were managed conservatively with good results. In our 2 cases, the diagnosis of CA and SMA dissection was established by contrastenhanced CT and confirmed by conventional angiograghy. One patient was treated with anticoagulation and antihypertension, and the other patient was treated with endovascular stenting. Both of the patients didn＇t have discomfort during the follow-up period of 12 and 3 months respectively. Conclusions Contrast- enhanced abdominal CT is the main tool for detection of IDVA. Most of the patients with IDVA can be managed conservatively, but close surveillance with imaging studies is necessary for early recognition of dissection progression. Patients with persistent or relapsed symptoms, and dissection progression, should undergo surgical or endovascular treatment.

关 键 词：夹层 腹腔干 肠系膜上动脉 

分 类 号：R657.2[医药卫生—外科学]