复杂B型主动脉夹层腔内修复术后肠系膜上动脉灌注改变分析  

Analysis of Perfusion Changes in the Superior Mesenteric Artery After Endovascular Repair of Complex Type B Aortic Dissection

作　　者：李铁铮[1] 韩晓峰[1] 刘光锐[1] 郭曦[1] Li Tiezheng;Han Xiaofeng;Liu Guangrui(Department of Diagnostic and Interventional Radiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院介入诊疗科,北京100029

出　　处：《中国微创外科杂志》2019年第12期1057-1061,1065,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：国家重点研发计划(2017YFC1308005)。

摘　　要：目的 探讨复杂B型主动脉夹层腔内修复术后肠系膜上动脉(superior mesenteric artery,SMA)灌注改变情况。方法 回顾性分析2015年10月~2018年10月257例B型主动脉夹层腔内修复术资料,其中SMA受累143例。收集术前和术后主动脉CTA影像资料,基于分支血管缺血细化分型,分析术前和术后SMA血流灌注改变情况。结果 143例SMA受累夹层均顺利植入主动脉覆膜支架,且未同期处理SMA。SMA灌注受损缺血占10. 5%(15/143),其中动力型灌注受损7例,静力型灌注受损8例。术前CTA提示侧支循环通路形成10例,包括腹腔干-SMA通路3例,肠系膜下动脉(inferior mesenteric artery,IMA)-SMA通路7例。腔内修复术后,13例1周内腹部不适症状消失,2例间断饱腹后腹胀,无需进一步手术。术后复查CTA显示,除2例SMA灌注类型维持不变且侧支循环通路仍开放外,余13例SMA灌注类型均改善,且8例侧支循环通路未再显示。术前CTA显示SMA灌注好的128例中,除4例由Ⅰ-a型转为正常型即假腔完全血栓化吸收外,余124例维持术前灌注类型不变。结论 复杂B型主动脉夹层累及SMA缺血多数属动力型,缺血灌注受损型比例较低,腔内修复术不仅能隔绝原发破口防止夹层破裂,同时能有效改善缺血的SMA灌注情况。Objective To investigate changes of superior mesenteric artery(SMA)perfusion after endovascular repair for complex type B aortic dissection.Methods A retrospective analysis was made on 257 cases of type B aortic dissection treated with endovascular repair from October 2015 to October 2018,143 of which had SMA malperfusion.Based on the analysis of aortic computed tomography angiography(CTA)imaging on the axis and 3D reconstruction,the perfusion pattern of SMA ischemia in preoperation as well as perfusion pattern changes in postoperation were assessed.Results All the 143 patients were successfully implanted with stentgrafts,while the SMA was not implanted with stent spontaneously.SMA ischemia caused by aortic dissection accounted for 10.5%(15/143)of patients,with 7 cases of dynamic ischemia and 8 cases of static ischemia.Among the 15 patients with ischemic malperfusion before endovascular repair,10 cases showed with collateral circulation pathway,including 3 cases of celiac trunk-SMA pathway and 7 cases of inferior mesenteric artery(IMA)-SMA pathway.After endovascular repair,13 cases with abdominal discomfort recovered and 2 cases with intermittent abdominal distension needed follow-up observation.The perfusion type of SMA remained unchanged and the collateral circulation pathway still existed in 2 cases,and the collateral circulation pathway was not shown in 8 cases.Among the 128 patients with SMA well-perfusion in perioperative period,no change of perfusion type was seen in 124 patients,except for 4 cases of displayed change in perfusion type from typeⅠ-a to normal,which showed completed thrombus absorption in false lumen.Conclusions Most of SMA ischemia in complex type B aortic dissection are dynamic type,and the proportion of ischemic malperfusion is low.Endovascular repair can not only prevent dissection rupture,but also effectively improve the perfusion of ischemic SMA.

关 键 词：肠系膜上动脉 侧支循环通路 B型主动脉夹层 腔内修复术 

分 类 号：R73[医药卫生—肿瘤]