自发孤立性肠系膜上动脉夹层分支动脉受累特征的初步观察  

CT angiography features of the involved arterial branches of the spontaneous isolated superior mesenteric artery dissection

作　　者：彭珂文[1] 高燕[2] 楚二伟[1] 沈比先[1] 高德宏[1] 罗继武 

机构地区：[1]广东医学院附属深圳市南山人民医院放射科,518052 [2]广东医学院附属深圳市南山人民医院消化科 [3]广东医学院附属深圳市南山人民医院胃肠外科

出　　处：《中华胃肠外科杂志》2014年第3期264-267,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨自发孤立性肠系膜上动脉夹层（SISMAD）中受累分支动脉的cT血管造影特点。方法回顾性分析经双源CT动脉造影确诊的6例SISMAD患者的临床资料，对其肠系膜上动脉（SMA）分支的影像学特征进行分析。结果6例SISMAD患者中2例未出现分支动脉受累，其SMA的夹层范围局限于近中段：另4例共10支空回肠动脉可见夹层。其SMA的夹层范围均为开口近侧至SMA远端。9支空回肠动脉夹层的假腔均呈壁间血肿改变，横截面呈偏心性“靶征”，纵轴面呈“夹心”改变，另1支空回肠动脉闭塞。7支受累空回肠动脉与SMA夹层的假腔相通。受累空回肠动脉的真腔管径比明显低于SMA近中段和远段（P〈0．01，P〈0．05）。6例患者均经保守治疗好转。结论SISMAD范围广泛的病例可能更易出现分支动脉受累，而分支动脉夹层的分布与形态具有一定的自身影像学特点。Objective To explore the CT angiography features of the involved arterial branches of the spontaneous isolated superior mesentery artery dissection （SISMAD）. Methods Clinical and CT angiogram data of 6 patients with SISMAD confirmed by dual source energy CT angiography were analyzed retrospectively. The CT angiography features and prognosis of patients were investigated. Results Average age of 6 patients was（45.S3＋5.60） years old. Ten branches of jejunoileal artery were involved in 4 patients. All the dissections of the superior mesenteric arteries （SMA） were extended from its proximal to its end. Intramural hematoma was found in all the involved branches, which showed eccentric target sign in the transverse section and sandwich sign in the longitudinal axial section. In 7 branches of 3 patients, the involved branches originated from the false lumina of the SMA. In one patient, the intramural hematoma of the jejunoileal arteries was found to be completely absorbed in a repeated CT angiography one year late. Conclusions For the SISMAD, the involvement of the branches of the SMA may be associated with the extension of the dissection of the SMA. The inflation of the false lumina of the branches is worse than that of the SMA. With the improvement of the dissection of the SMA, the intramural hematoma of the branches can be absorbed. The conservative treatment may be the first choice for SISMAD without emergency.

关 键 词：夹层动脉瘤 肠系膜上动脉 动脉分支 体层摄影术 x线计算机 血管造影 

分 类 号：R572.3[医药卫生—消化系统] R816.2[医药卫生—内科学]