6例肠系膜上动脉瘤的诊治经验  

Clinical experience in the diagnosis and treatment of 6 cases of superior mesenteric artery aneurysm

作　　者：连利珊[1] 赵宁 杨洋 吴志远 刁永鹏[2] 冯海[1] 陈学明[1] 李拥军[2] Lian Lishan;Zhao Ning;Yang Yang;Wu Zhiyuan;Diao Yongpeng;Feng Hai;Chen Xueming;Li Yongjun(Department of Vascular Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Vascular Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京友谊医院血管外科,北京100050 [2]国家老年医学中心北京医院血管外科、中国医学科学院老年医学研究所,北京100730

出　　处：《中华血管外科杂志》2023年第4期331-336,共6页Chinese Journal of Vascular Surgery

摘　　要：目的总结肠系膜上动脉瘤(SMAA)的诊治经验。方法本研究为回顾性纵向研究。回顾性分析2015年1月至2023年1月北京友谊医院和北京医院两个中心的6例SMAA患者的临床资料,其中4例为真性动脉瘤,包括肠系膜上动脉(SMA)主干动脉瘤2例及SMA分支动脉瘤2例;另2例为肠系膜上动脉夹层动脉瘤。所有患者均通过盆腹腔增强CT确诊,其中腹痛4例,均为脐周隐痛。SMAA瘤体直径为(25.0±3.7)mm。总结分析患者的病因、发病特点、影像学表现、解剖特点及治疗方法等。结果6例患者中,2例分支动脉SMAA,其中1例保守治疗,另1例行瘤体弹簧圈栓塞术治疗;2例主干SMAA,行SMAA切除加人工血管重建及SMAA成形术及肝总动脉-SMA自体大隐静脉重建;另2例夹层动脉瘤,其中1例行假腔弹簧圈栓塞及真腔支架重塑,1例行两层裸支架植入。4例腹痛患者术后症状缓解。随访时间为(19.1±5.2)个月,随访期内复查CT血管造影可见SMA支架、人工血管及自体静脉桥均通畅,无再发SMAA。结论症状性SMAA且直径超过2 cm,应积极手术干预,但具体的手术方法应根据SMAA的解剖部位及交通动脉的评估而定。Objective To investigate the diagnosis and treatment of superior mesenteric artery aneurysm(SMAA).MethodsThis study was a retrospective longitudinal study.A total of 6 cases with SMAA from two centers,Beijing Friendship Hospital and Beijing Hospital were retrospectively reviewed from January 2015 to January 2023.Among the six patients,4 cases had true aneurysms,including superior mesenteric artery(SMA)trunk aneurysm and SMA branch aneurysm,and the other 2 cases were SMA dissecting aneurysms.All patients were confirmed by the enhanced computed tomography(CT)of the abdomen and pelvis.Four patients(66.7%,4/6)had abdominal pain,all of which were periumbilical pain.The mean diameter of SMAA was(25.0±3.7)mm.The clinical data were analyzed,including etiology,pathogenesis,imaging findings,anatomical location of the aneurysms,and their treatment methods.ResultsAmong the 6 patients,2 patients with SMAA on the branch underwent conservation treatment in 1 case and spring coil embolization in 1 case;2 patients with SMAA on the main trunk underwent SMAA resection,artificial vessel reconstruction,and the reconstruction of hepatic artery-SMA with autologous great saphenous vein;besides,in 2 cases with SMA dissecting aneurysms,1 case was embolized with spring coils at the false cavity and remodeled with a true cavity stent,and the other one was implanted with double-layer bare stents.Abdominal pain relieved in 4 patients postoperative.The follow-up time was(19.1±5.2)months,which reported no recurrence of SMAA in patients after surgery,according to the CT.The SMA stents,artificial blood vessels,and autologous vein bypass featured patency.ConclusionSymptomatic SMAA with a diameter of more than 2 cm should be actively treated with surgical or endovascular intervention,but the optimal method depends on the anatomical site and the evaluation of communicating arteries of SMAA.

关 键 词：肠系膜上动脉瘤 腹痛 腔内治疗 开放手术 

分 类 号：R572.3[医药卫生—消化系统]