孤立性肠系膜上动脉夹层患者临床疗效分析  

作　　者：余钻标 郎德海[1] 胡松杰[1] 王迪[1] 胡明[1] 徐祺洋 

机构地区：[1]浙江省宁波市第二医院,315000

出　　处：《浙江临床医学》2018年第3期428-430,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省宁波市第二医院重点学科项目（2016-57）

摘　　要：目的观察自发性孤立性肠系膜上动脉夹层患者采用腔内介入治疗及保守治疗的疗效。方法回顾性分析2013年7月至2017年7月30例自发性孤立性肠系膜上动脉夹层的临床资料。入院前均经肠系膜上动脉CTA确诊。其中腔内介入治疗17例、保守治疗13例。出院后及随访半年内，应用CTA观察其夹层血栓化情况及腹痛症状缓解情况。结果30例患者中，17例（56．7％）患者予以放置支架成功（2例同时予以夹层动脉瘤栓塞）。另11例（36.7％）患者保守治疗良好。2例因反复尝试导丝均无法进入真腔，转保守治疗，随访半年期间无明显腹痛症状。结论对于孤立性肠系膜上动脉夹层的患者，需根据患者腹痛症状及结合CT影像结果综合评估治疗方式，对治疗期间腹痛症状缓解或CT复查夹层未进展可考虑保守治疗。反之，需要尽早实行腔内介入治疗，短期内可缓解症状，避免后期肠缺血坏死：Objective To investigate the clinical efficacy of endovascular therapy and conservative treatment in patients with isolated superior mesenteric artery dissection. Methods Retrospective analysis was performed on 30 patients with spontaneous isolated superior mesenteric artery dissection from July 2013 to July 2017.Before admission, the patient was diagnosed with CTA in the mesenteric artery. 17 of them were treated with iutcrvcntional therapy and 13 of routine conservative treammncAfter discharged and follow-up for half a year, CTA was used to observe the thrombosis of the sandwich and the relief of abdominal pain. Results 30 cases of patients, 17 cases （ 56.7% ） patients who successful stent implantation （ 2 cases at the same time be dissected aneurysm embolization ） .In the other 11 cases （ 36.7% ） , the patients were treated with conservative treatment, and the symptoms ofabdontinal pain were relieved during the hospitalization. No progress was made in the examination of the CTA in the inesenteric artery, and the distal blood supply was unobstructed.The two cases were not able to enter the real cavity by repeated attempts, and the treatment was conservative, and the symptoms of abdominal pain were not evident during the follow-up period. Conclusion For the isolation superior mesenteric artery dissection patients, the treatment should be integrated evaluated according to the patient＇s abdominal pain symptoms and CT imaging results. Conservative treatment can be considered when the symptoms of abdominal pain are relieved during the treammnt or when the CT reexamination of dissection is not progressing.On the contrary, the interventional therapy is necessary as soon as possible to relieve symptoms in the short term, and to avoid the late intestinal ischemic necrosis.

关 键 词：孤立性肠系膜上动脉夹层 腔内介入 保守治疗 

分 类 号：R657.2[医药卫生—外科学]