慢性肠系膜上动脉狭窄／闭塞的诊疗策略  

Diagnostic and therapeutic options for superior mesenteric artery stenosis/ocdusion

作　　者：杨宝钟[1] 宋盛晗[1] 邢彤[1] 张望德[1] 原标[1] 李谈[1] 廖传军[1] 张扬[1] 苑超[1] 

机构地区：[1]首都医科大学附属北京朝阳医院血管外科,100020

出　　处：《中华胸心血管外科杂志》2013年第11期663-666,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨肠系膜上动脉（SMA）狭窄／闭塞所致缺血性肠病的诊断和治疗策略。方法20例SMA狭窄／闭塞患者，男14例，女6例；年龄40-75岁，平均67．5岁。病程1—62个月，平均15．5个月。5例SMA闭塞患者采用外科治疗，15例患者（11例狭窄、4例闭塞）行SMA球囊扩张＋支架置人术。术后常规使用抗凝药物。17例随访1—32个月，平均11．5个月。结果全组术后1周内症状消失，疗效满意。随访期间，1例行支架置人患者术后32个月死于突发心肌梗死。支架闭塞和支架内约50％的狭窄各1例，但症状轻微，根据患者的意愿未处理；支架轻度狭窄（约30％）3例，患者无任何腹部不适，暂未处理；1例转流患者术后18个月时突发持续性腹痛，手术探查，经人工血管取栓后造影发现人工血管与SMA吻合口狭窄，再行PTA＋球囊扩张支架置入术，正在随访中。其余患者随访期间未发现SMA再狭窄／闭塞征象。结论腔内治疗可作为SMA狭窄／闭塞致肠缺血的首选治疗方法。对于复杂病例采用杂交手术治疗，可以减少并发症的发生。Objective To discuss the diagnosis and treatment options for ischemic enteropathy due to superior mesenter- ic artery （SMA） stenosis/occlusion. Methods Five cases with SMA occlusion were treated surgically and 15 cases underwent balloon angioplasty and stent implantation. Post-procedure anticoagulative and antiplatelet therapy were employed routinely. 17 cases were followed up for 3 to 32 months. Results All patients achieved satisfactory results with disappearance of symptoms within one week postoperatively. One patient with stent placement died suddenly 32 months postoperatively due to acute myo- cardial infarction although he was free of abdominal symptoms during follow-up period. Stent occlusion and in-stent stenosis of about 50% were found in I case each, and mild in-stent stenosis （ approximately 30% ） were present in 3 cases. No further in- tervention were adopted for the above-mentioned patients; Sudden persistent abdominal pain occurred at 18th month postopera- tively in one patient who had received SMA embolectomy and infrarenal aorto-SMA bypass due to SMA total occlusion. Graft-to- SMA anastomotic stenosis was revealed during intraoperative angiography following graft- and SMA embolectomy, and one bal- loon expandable stent was deployed at the anastomosis. He recovered uneventfully and is currently being observed. No signs of SMA stenosis / occlusion were found in the remaining patients during follow-up period. Conclusion Duplux, CTA and angi- ography are of great significance to the diagnosis of SMA stenosis / occlusion. Endovascular treatment is the procedure of choice for this entity. In complicated cases with high surgical risk, the ingenious combination of different treatment modalities （ hybrid technique） can simplify treatment and reduce the incidence of complications.

关 键 词：肠系膜上动脉 狭窄 病理性 肠系膜血管闭塞 血管成形术 腔内治疗 

分 类 号：R654.3[医药卫生—外科学]