自发性孤立性肠系膜上动脉夹层的腔内治疗  

Endovascular treatment of spontaneous isolated dissection of the superior mesenteric artery

作　　者：周建国[1] 李栋林[1] 何杨燕 张鸿坤[1] 

机构地区：[1]浙江大学医学院附属第一医院血管外科,杭州310003

出　　处：《中华普通外科杂志》2015年第12期949-952,共4页Chinese Journal of General Surgery

摘　　要：目的总结自发性孤立性肠系膜上动脉夹层（spontaneousisolateddissectionofthesuperiormesentericartery，SIDSMA）的临床特点及腔内治疗的有效性。方法回顾性分析2013年1月至2014年6月浙江大学医学院附属第一医院血管外科收治的48例SIDSMA患者的临床资料。其中男41例，女7例，年龄32-78岁，平均（55±8）岁。临床症状腹痛45例，3例无症状患者行保守治疗。所有病例均经CTA确诊。结果45例有症状患者中1例行肠系膜上动脉（superiorruesentericartery．SMA）切开取栓、坏死肠管切除术，其余均行腔内介入治疗，其中2例因导丝无法进入真腔而介入失败而转保守治疗，其余42例均成功行血管腔内成形治疗。42例患者均获随访，随访时间10～28个月．平均（17±4）个月。42例成功介入腔内治疗后CTA复查显示42例真腔通畅。介入失败转保守治疗的2例患者在随访中有反复腹痛，消化功能不全的表现。结论介入腔内治疗对于SIDSMA是安全有效的。Objectives To evaluate the effect of endovascular treatment for spontaneous isolated dissection of the superior mesenteric artery （ SIDSMA）. Methods There were 41 men and 7 women patients, aged at 32 - 78 years. 46 patients presented with abdominal pain and 3 patients was asymptomatic. The SIDSMA was diagnosed by computed tomography angiography（CTA）. Results In the 45 symptomatic patients, one was treated by laparotomy, SMA thrombectomy and necrotic bowel resection. 44 patients underwent endovasular treatment, among them 2 patients failed endovasular procedure. The other 42 patients underwent successful intravascular remolding. 3 asymptomatic patients underwwent conservative treatment. During the mean （17 ± 4 ）month follow-up period, computed tomography angiography showed patent true famen in all the 42 patients. The 2 patients in which the endovascu[ar intervention failed remain symptomatic of recurrent abdominal pain and digestive dysfunction. Conclusions The endovascular interventional therapy is safe and effective for SIDSMA.

关 键 词：肠系膜上动脉 血管成形术 支架 夹层 

分 类 号：R572.3[医药卫生—消化系统]