症状性自发孤立性腹腔干动脉夹层的形态学特征及临床治疗策略分析  

Morphologic characteristics and management strategy of symptomatic spontaneous isolated celiac artery dissection

作　　者：彭振宇 化召辉[1] 焦周阳[1] 徐鹏[1] 曹辉[1] 刘仕睿 李震[1] PENG Zhenyu;HUA Zhaohui;JIAO Zhouyang;XU Peng;CAO Hui;LIU Shirui;LI Zhen(Department of Endovascular Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,P.R.China)

机构地区：[1]郑州大学第一附属医院腔内血管外科,郑州450052

出　　处：《中国普外基础与临床杂志》2021年第10期1340-1347,共8页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的根据综合症状性自发孤立性腹腔干动脉夹层(SICAD)患者的动脉真腔相对直径(TLRD)和病变类型的形态学分型,总结症状性SICAD患者的形态学分型特征及其合理的治疗策略与血流重建时机。方法回顾性分析郑州大学第一附属医院腔内血管外科于2012年5月至2019年5月期间收治的26例症状性SICAD患者的临床资料,根据处置方式分为保守治疗组12例和腔内干预组14例,比较2组患者的临床症状、影像资料、形态学分型、治疗方式、围手术期并发症及随访结果。结果保守治疗组12例患者中,11例患者的TLRD≥30%,真腔管径较大,动脉血供充足,平均保守治疗12.6 d后症状明显改善出院。腔内干预组14例患者中,12例患者的TLRD≥30%或瘤体直径>1.5 cm,保守治疗无效后选择腔内干预,平均保守治疗时间为11.4 d。与腔内干预组比较,保守治疗组的症状持续时间较短(P=0.04),背痛(P=0.02)和胸痛(P=0.04)比例较低,TLRD值更高(P=0.01),TLRD>30%(a类亚型)的比例更高(P=0.02)。本组患者平均随访时长为28.2个月(12~83个月)。保守治疗组所有患者随访结果良好,随访期间未出现相关症状。腔内干预组1例患者出现一过性肝功能损伤,1例腹腔干动脉支架置入术后1年出现支架近端变形严重,其余患者随访期间病情稳定无进展。结论对于症状性SICAD,如果入院后临床症状稳定,可首选药物保守加密切的影像学随访;若在药物保守治疗基础上,存在症状无缓解、器官持续灌注不足等表现,可考虑腔内干预进行血流重建,该治疗方法下的早中期随访结果满意。此外,本研究提出的分型对临床治疗策略的制定有着潜在的指导意义。Objective To summarize the clinical morphological classification feature of symptomatic spontaneous isolated celiac artery dissection(SICAD),basing on the relative diameter of the true lumen(TLRD)and type of lesion,and then summarize the reasonable clinical treatment strategies and timing of arterial reconstruction.Methods Retrospectively analyzed the imaging data,treatment methods,perioperative complications,and follow-up results of 26 symptomatic SICAD patients admitted to the Department of Endovascular Surgery of The First Affiliated Hospital of Zhengzhou University from May 2012 to May 2019,patients were divided into conservative treatment group(n=12)and endovascular intervention group(n=14)according the treatment,and then compared the clinical data of the two groups.Results Twelve patients in the conservative treatment group had an average of 12.6 days(5–22 days)and discharged from hospital with better condition,of which 11 patients’TLRD≥30%.In the endovascular intervention group,2 patients continued to aggravate the symptoms at the 3 rd day of admission and received endovascular intervention,the remaining 12 patients’symptoms were not significantly relieved or the symptoms reappeared after averaged 11.4 days,whose TLRD<30%or diameter>1.5 cm.Compared with the endovascular intervention group,the duration of symptoms was shorter(P=0.04),proportions of back pain(P=0.02)and chest pain(P=0.04)were lower,TLRD value and proportion of TLRD value>30%(subtype of a)were higher(P=0.01,P=0.02).The average follow-up duration of 26 patients was 28.2 months(12–83 months).The follow-up results of all patients in the conservative treatment group were good and no relevant symptoms had appeared since discharge.One patient in the endovascular intervention group had transient liver function damage,1 patient had severe deformation of the proximal end of the stent at 1 year after implantation of the celiac artery stent.The remaining patients were stable with no progress.Conclusions For symptomatic SICAD,if the clinical sy

关 键 词：症状性自发孤立性腹腔干动脉夹层 形态学分型 治疗策略 血流重建 

分 类 号：R654.4[医药卫生—外科学]