自发性孤立性肠系膜上动脉夹层的CT诊断和介入治疗(附6例报道)  

CT Diagnosis and Interventional Therapy for Spontaneous Isolated Dissection of Superior Mesenteric Artery

作　　者：苏浩波[1] 顾建平[1] 楼文胜[1] 何旭[1] 陈亮[1] 陈国平[1] 宋进华[1] 汪涛[1] 徐克[2] 

机构地区：[1]南京医科大学附属南京医院介入科,210006 [2]中国医科大学附属第一医院放射科,沈阳110001

出　　处：《临床放射学杂志》2012年第9期1324-1329,共6页Journal of Clinical Radiology

基　　金：国家科技部"十一五"科技支撑计划资助项目(编号:2007BAI05B04)

摘　　要：目的探讨自发性孤立性肠系膜上动脉夹层(SISMAD)的CT表现及评价介入治疗的安全性和疗效。方法回顾性分析6例(男5例,女1例;症状性5例,无症状性1例,平均年龄52.3岁)SISMAD患者CT及DSA造影表现特征,以及介入治疗方法和术后临床及影像学随访结果。结果 6例患者CT及DSA均清楚显示病灶,横轴面CT、多平面重组(MPR)及曲面重组(CPR)图像均可显示夹层真假双腔、内膜破裂口、假腔内血栓、真腔狭窄程度等,按照Sakamoto血管影像学分型:TypeⅠ型1例、TypeⅡ型1例、TypeⅢ型4例,全部患者均接受介入治疗,其中弹簧圈栓塞1例,支架联合弹簧圈栓塞2例,双支架重叠技术3例,技术成功率100%,无并发症。术后随访3～12个月(平均7个月),5例症状性患者术后3周内症状消失。5例患者术后3～6个月时肠系膜上动脉CTA及血管造影动脉瘤腔均不显影,支架腔内血流通畅、夹层愈合。结论 CT增强扫描及CTA检查能清楚显示SISMAD,可作为本病的首选检查方法;介入治疗SISMAD是一种微创、安全、有效的方法。Objective To explore CT features of spontaneous isolated superior mesenteric artery dissection（SISMAD） and the efficacy of interventional treatment for SISMAD. Methods CT and DSA features of 6 patients （5 symptomatic patients and 1 asymtomatic patient; 5 male and 1 female; mean age 52.3 years,range,37 -68 years） with SISMAD were retrospectively reviewed. Results CT and DSA showed SISMAD clearly. Axial CT, MPR and CPR could display true and false lumen and detached intimal flap, including ruptured intimal orifice, thrombus in the false lumen and stenosis of true lu- men. Interventional therapy was achieved in all patients, according to Sakamoto Angiographic Classification, there were Type I （n = 1 ）,Type 11 （n = 1 ）, Type II1 （ n = 4 ）, no complications were occurred. 2 cases were preformed combination of coil embolization and stent placement, 3 eases received double stent placement and 1 case was treated with coil embolization. All patients were asymptomatic gradually in 3 weeks. CT or DSA were available in 5 patients （ mean 7 months, range 3 - 12 months） and showed complete resolution of the dissection and successful restoration of the true lumen with good distal flow of the SMA. Conclusion As noninvasive methods, enhanced CT scan and CTA can display SISMAD clearly. Interventional therapy is a feasible and effective treatment strategy for SISMAD.

关 键 词：肠系膜上动脉 夹层 CT血管成像 数字减影血管造影 介入治疗 

分 类 号：R657.2[医药卫生—外科学]