经腹小切口逆行支架成形术治疗症状性慢性肠系膜上动脉闭塞九例  

Management of symptomatic chronic superior mesenteric artery occlusion by minimally trans- abdominal incision retrograde stent angioplasty

作　　者：吴鉴今[1] 曲乐丰[1] 职康康[1] 柏骏[1] 吴永发[1] 金杰[1] 邹思力[1] 贺元[1] 王昊邈 王亮[1] 季相国 

机构地区：[1]第二军医大学附属长征医院血管外科,上海200003

出　　处：《中华普通外科杂志》2015年第12期933-936,共4页Chinese Journal of General Surgery

基　　金：基金项目：上海市科委2012年度“创新行动计划”基础研究重点项目基金资助项目（12JC1411202）;国家自然科学基金面上项目基金资助项目（8157020854）

摘　　要：目的总结经腹小切口逆行支架成形术治疗症状性肠系膜上动脉慢性完全闭塞性病变（symptomaticchronicsuperiormesentericartec^occlusion，SCSMAO）的经验。方法回顾性分析自2012年4月至2014年3月上海长征医院血管外科采用经腹小切口逆行穿刺肠系膜上动脉（superiormesentericartery，SMA）行球扩支架成形术治疗9例SCSMAO患者的临床资料。记录切口长度、穿刺位置、穿刺成功率、有无动脉夹层发生、支架类型及尺寸、出血量、造影剂量和手术时间等。随访观察症状改善情况及有无再狭窄发生。结果技术成功率100％。切口平均长度（5．8±0．6）cm．穿刺成功率100％，动脉夹层等围手术期并发症发生率0％。均成功置人球扩支架（BostonScientific，ExpressLD^TM）：1例为7mm×19mm、7例为8mm×37toni、1例为9mm×37mm，术后造影通畅率均〉85％。9例患者均获随访，平均随访时间（17±9）个月，全组患者术后1周内症状消失、食欲改善，术后6个月体重平均增加（4．9±1．2）kg，出现无症状性支架内再狭窄1例（11．1％），无支架断裂发生。结论采用经腹小切口逆行支架成形术治疗SCSMAO，可行性好、疗效确切，兼具较好的安全性，为SCSMAO的治疗提供了新的选择。Objective To evaluate the feasibility, safety and validity of minimally trans-abdominal incision retrograde stent angioplasty for the treatment of symptomatic chronic superior mesenterie artery occlusion （SCSMAO）. Methods A retrospective analysis was made on 9 SCSMAO patients who received minimally trans-abdominal incision retrograde stent angioplasty. Data of the incision length, puncture position, puncture success rate, whether arterial dissection occurs, implanted stent type and size, blood loss, contrast dose and operation time of the procedure were collected. Results The technical success rate was 100%. Mean incision length was （5.8 ±0. 6）cm and arterial puncture success rate was 100% with no artery dissection and other perioperative major complications. Balloon expandable stents （Boston Scientific, Express LDTM） was implanted in all 9 cases successfully, with the size of 7 mm x 19 mm in 1 case, 8 mmx 37 mm in 7 cases and 9 mm x 37 mm in 1 case. Patency rate as confirmed by immediate postoperative angiography was 85%. Shown by follow-up of （ 17 ± 9） months, all 9 patients reported symptoms disappeared and appetite improved within 1 week after the operation, the mean post 6 months operation weight increase was （4. 9 ± 1.2 ） kg. One had an asymptomatic in-stent restenosis. There was no stent fracture happened during the follow-up. Conclusions Minimally trans-abdominal incision retrograde stent angioplasty offered new options in the management of SCSMAO.

关 键 词：肠系膜血管闭塞 血管成形术 支架 

分 类 号：R657.2[医药卫生—外科学]