急性肠系膜上动脉栓塞的综合腔内治疗  

Endovascular therapy of superior mesenteric artery embolism

作　　者：李文东[1] 李晓强[1] 孟庆友[1] 钱爱民[1] 桑宏飞[1] 朱礼炜[1] 张晔青[1] 戎建杰[1] 王文斌[1] 赵铁军[1] 

机构地区：[1]苏州大学附属第二医院血管外科,215001

出　　处：《中华医学杂志》2013年第47期3752-3754,共3页National Medical Journal of China

摘　　要：目的探讨肠系膜上动脉栓塞的腔内介入治疗方法的安全性及近期疗效。方法2007年11月至2012年10月苏州大学第二附属医院血管外科采用腔内介入技术治疗肠系膜上动脉栓塞病例18例，男13例，女5例，合并有房颤者有8例，有风湿性心瓣膜病3例，均行腹主动脉cT检查明确诊断，栓塞部位主要位于距肠系膜上动脉开口3～10em处，其中有3例患者经股动脉行肠系膜上动脉取栓术，术后外周抗凝溶栓治疗；经股动脉行肠系膜上动脉取栓术＋球囊扩张术2例；经股动脉行肠系膜上动脉取栓＋置管溶栓术者6例；单纯行肠系膜上动脉置管溶栓术者5例；经股动脉行肠系膜上动脉取栓＋置管溶栓＋球囊扩张术者2例。结果技术成功率100％，2例患者术前术后造影对比提示胴动脉内新发生栓塞，行股动脉切开取栓术后下肢再通，其余患者术前术后造影对比未见新发生的栓塞，足背动脉搏动于术前术后未见明显变化。其中1例患者发生腹膜刺激症，患者自动出院后死亡，其余患者术后腹痛均得到缓解，且治疗过程中无肠坏死表现，均未行剖腹探查或肠切除手术治疗，术后6个月行彩超或腹部增强CT提示肠系膜上动脉通畅，其中有2例存在局部狭窄。结论腔内介入手术治疗在肠系膜上动脉栓塞的治疗中安全有效，近期效果满意。Objective To explore the safety and immediate efficacy of endovascular treatment for superior mesenteric artery embolism. Methods From November 2007 to October 2012, 18 cases of superior mesenteric artery embolism were treated by thrombus extraction and/or catheter-directed thrombolysis. There were 13 males and 5 females with an age range of 44 - 91 years. The concurrent conditions included atrial fibrillation （n = 8 ） and rheumatic valve disease （n = 3 ）. All diagnoses were made with abdominal enhanced computed tomography （CT） examination. Embolism was predominantly located at 3 to 10 cm away from opening. The procedures included thrombus extraction plus system thrombosis （ n = 3 ） , thrombus extraction and catheter-directed thrombolysis （ n = 6）, catheter-directed thrombolysis （ n = 5 ） and thrombus extraction, catheter-directed thrombolysis and PTA （n = 2）. Results The technical success rate was 100%. Two cases had new embolism in popliteal artery. Another case with peritoneal irritation syndrome died after automatic discharge. The other 17 patients obtained satisfactory results and were followed up after 6 months by color Doppler ultrasound or abdominal enhanced CT. It showed that superior mesenteric arteries were unobstructed, but local stenosis occurred in 2 cases. Conclusion Endovascular interventional therapy is both safe and efficacious in the treatment of superior mesenteric artery embolization. And its immediate effect is satisfactory.

关 键 词：肠系膜上动脉 栓塞 置管溶栓 

分 类 号：R656.4[医药卫生—外科学]