急性自发性孤立性内脏动脉夹层诊疗分析  

Diagnosis and treatment of acute spontaneous isolated visceral artery dissection

作　　者：王辉[1] 高秀娟[2] 马佩[3] 李朋[1] 陈刚[4] 韩新强[4] 盛玉国[4] 徐英江[4] Wang Hui;Gao Xiujuan;Ma Pei;Li Peng;Chen Gang;Han Xinqiang;Sheng Yuguo;Xu Yingjiang(Department of Trauma Center,Binzhou Medical College Hospital,Shandong Binzhou 256603,China;Department of Neurovascular,Binzhou Medical College Hospital,Shandong Binzhou 256603,China;The First Affiliated Hospital of Nanjing Medical University,Jiangsu Nanjing 210029,China;Department of Interventional Vascular Surgery,Binzhou Medical College Hospital,Shandong Binzhou 256603,China)

机构地区：[1]滨州医学院附属医院创伤中心,山东滨州256603 [2]滨州医学院附属医院神经血管外科,山东滨州256603 [3]南京医科大学第一附属医院,江苏南京210029 [4]滨州医学院附属医院介入血管外科,山东滨州256603

出　　处：《腹部外科》2020年第4期270-273,286,共5页Journal of Abdominal Surgery

摘　　要：目的探讨急性自发性孤立性内脏动脉夹层(acute spontaneous isolated visceral artery dissection,AVAD)的发病特点及诊治策略。方法回顾性分析25例AVAD病人临床资料,分析其临床表现、诊疗经过及随访结果。结果25例AVAD病人(男性100%),平均年龄54.5岁(28~74岁)。初始行腔内治疗(裸支架置入术)的病人1例;开放手术治疗1例;初始接受抗凝、抗血小板治疗的病人共23例,其中16例病人保守治疗1周后腹痛症状明显改善,保守治疗有效率为70%(16/23)。随访期间有5例病人出现夹层进展,转行腔内治疗,1例病人因长期反复的慢性腹痛转行腔内治疗,1例病人发现夹层动脉瘤转为腔内治疗。5例病人在随访期间经历了短期的餐后腹胀情况,后渐缓解。其余病人在随访期间均未出现症状复发,CT血管造影(CTA)随访结果示76%(19/25)病人夹层假腔血栓化,真腔血供改善。结论抗栓药物的非手术治疗应是AVAD的一线治疗方案,当怀疑肠缺血或夹层病变进展时,腔内治疗是安全可行的治疗方法。弥漫性腹膜炎出现时,应及时手术治疗。Objective To explore the clinical characteristics,diagnosis and treatment strategy of acute spontaneous isolated visceral artery dissection(AVAD).Methods 25 patients with AVAD were collected retrospectively.Clinical features,treatment modalities,and follow-up results were reviewed according to medical records.Results Twenty-five patients(100%male)with AVAD had a mean age of 54.5 years(28 to 74 years).One patient initially underwent endovascular treatment(bare stent implantation);1 patient was treated with open surgery;23 patients initially received anticoagulant and antiplatelet therapy,of which 16 patients had significant improvement in abdominal pain symptoms after one week of conservative treatment,with a conservative treatment response rate of 70%(16/23).During the follow-up period,5 patients had dissection progression and were converted to endovascular treatment,1 patient was converted to endovascular treatment due to long-term recurrent chronic abdominal pain,and 1 patient was found to have dissecting aneurysm and was converted to endovascular treatment.Five patients experienced short-term abdominal distension during follow-up,which gradually resolved.The other patients had recurrence of symptoms during follow-up.CTA follow-up results showed that 76%(19/25)of patients had thrombosis of the dissecting false lumen and the true lumen was improved.Conclusion Conservative management with antithrombotic agents should be a first-line regimen for AVAD.If intestinal ischemia and dissection progression are suspected,endovascular intervention is a safe and feasible treatment.When diffuse peritonitis is present,surgical treatment should be promptly performed.

关 键 词：内脏动脉 夹层 腹痛 

分 类 号：R657.2[医药卫生—外科学]