自发性孤立性肠系膜上动脉夹层的诊断和非手术治疗  

Diagnosis and non-operative therapies of spontaneous isolated of superior mesenteric artery dissection

作　　者：滕云飞[1] 李文毅 郑鸿[1] 蔡传奇[1] 金毕[1] 李毅清[1] 赖传善[1] 欧阳晨曦[1] 

机构地区：[1]华中科技大学附属协和医院血管外科,武汉430022 [2]忻州市人民医院血管外科

出　　处：《临床心血管病杂志》2012年第10期771-773,共3页Journal of Clinical Cardiology

摘　　要：目的:探讨自发性孤立性肠系膜上动脉夹层(SISMAD)的诊断和非手术治疗。方法:回顾性分析2008-02-2012-01收治的13例SISMAD患者的临床资料。结果:根据Sakamoto影像学分型,Ⅰ型夹层2例,Ⅱ型6例,Ⅲ型4例,Ⅳ型1例;11例保守治疗效果良好,已随访3～46个月(平均27.3个月),无明显腹部症状复发;CTA随访(8例)结果显示,SMA夹层稳定或不同程度改善,假腔内血栓减少,夹层远端动脉开放。2例保守治疗无效后改行腔内支架植入术,其中1例用弹簧圈栓塞假腔,已分别随访7个月和19个月,无腹部症状复发。结论:CT增强或CTA对于SISMAD的诊断具有重要帮助。保守治疗SISMAD有效,一旦无效或病情进展,根据病情改行腔内治疗或手术治疗。Objective：To explore the diagnosis and non-operative treatment of spontaneous isolated of superior mesenteric artery dissection （SISMAD）. Method： The 13 patients with SISMAD from Feb. 2008 through Jan. 2012 were retrospectively analyzed. Result： According to Sakamoto＇s classification, 2 cases of type I lesion, 6 cases of typeⅡ lesion, 4 cases of type Ⅲ lesion, 1 case of type Ⅳ lesion, were respectively shown on CTA. Effective results were observed in 11 cases by conservative treatments. There was no recurrent abdominal pain at a median follow-up of 27.3 months （range, 3- 46 months）. CTA resulte demonstrated that dissection was stable or improved, diminishing of thrombosis in false lumen and opening of distal artery to dissection. 2 cases were suc- cessfully intervented by endovascular stent and 1 case was treated with coil emholization in false lumen. There was no recurrent abdominal discomfort after 7 and 19 months respectively. Conclusion：Enhanced CT scan or CTA is the main method for diagnosis of SISMAD. Conservative treatment of SISMAD is effective. Once conservative treat- ment is in effective and the dissection is progressed, endovascular treatment or open surgery should be promptly performed based on the conditions.

关 键 词：肠系膜上动脉 夹层 增强CT扫描 CT血管造影 治疗 

分 类 号：R543[医药卫生—心血管疾病]