自发性孤立性肠系膜上动脉夹层患者的临床特点、MSCT征象及预后分析  

Clinical Characteristics,MSCT Signs and Prognosis of Spontaneous Isolated Superior Mesenteric Artery Dissection

作　　者：张萍 赵雪 吴静 ZHANG Ping;ZHAO Xue;WU Jing(Department of Imaging,Beijing Huairou Hospital,Huairou Teaching Hospital,Capital Medical University,Beijing 101400,China)

机构地区：[1]北京怀柔医院首都医科大学怀柔教学医院影像科,北京101400

出　　处：《中国CT和MRI杂志》2024年第4期144-146,共3页Chinese Journal of CT and MRI

摘　　要：目的探究自发性孤立性肠系膜上动脉夹层(SISMAD)患者临床特点、MSCT征象,并分析预后。方法选择北京怀柔医院2015年11月-2022年11月期间收治的85例SISMAD患者为研究对象,收集患者临床资料并给予MSCT检查,按照是否有临床症状将患者分为无症状组(n=16)和有症状组(n=69),比较两组临床特点、多层螺旋CT(MSCT)征象及预后。结果无症状组、有症状组SISMAD患者肠呜音减弱、合并高血压、合并有同型半胱氨酸升高、长期吸烟史等临床特点差异有统计学意义(P<0.05)。无症状组、有症状组SISMAD患者血栓形成、夹层解剖长度、入口直径、真腔直径、真腔狭窄程度、Yoo分型等MSCT征象差异有统计学意义(P<0.05)。16例无症状患者10例未经特殊处理仅观察,5例采取内科保守治疗,1例采取腔内治疗,病情均得到有效控制;69例有症状患者46例采取内科保守治疗,2例腹痛加剧转为腔内治疗,16例采取腔内治疗,7例采取旁路搭桥、内膜切除等外科手术治疗,病情均恢复良好。结论SISMAD临床表现一般以腹痛为主,但也存在部分无症状患者,血栓形成、夹层解剖长度、入口直径、真腔直径、真腔狭窄程度、Yoo分型有助于评价SISMAD病情严重程度,并指导后续治疗方案制定。Objective To investigate the clinical characteristics,MSCT signs and prognosis of spontaneous isolated superior mesenteric artery dissection(SISMAD).Methods A total of 85 patients with SISMAD admitted to Beijing Huairou Hospital from November 2015 to November 2022 were selected as the study subjects,and their clinical data were collected.All patients were examined with MSCT.The patients were divided into asymptomatic group(n=16)and symptomatic group(n=69)according to the presence or absence of clinical symptoms.Clinical characteristics,multi-slice spiral CT(MSCT)signs and prognosis of the two groups were compared.Results There were statistically significant differences between the asymptomatic group and the symptomatic group in term of clinical characteristics such as hypoactive bowel sound,hypertension,elevated homocysteine and long-term smoking history(P<0.05).The MSCT signs such as thrombosis,length of dissection,inlet diameter,diameter of true lumen,true lumen stenosis degree and Yoo classification in the two groups were significantly different(P<0.05).Among the 16 asymptomatic patients,10 patients were observed without special treatment,5 patients were given medical conservative treatment,and 1 patient was given intracavitary treatment.Condition of the 16 patients was effectively controlled.Among the 69 symptomatic patients,46 patients were given medical conservative treatment,2 patients were converted to intracavitary treatment for worsening abdominal pain,16 patients were given intracavitary treatment,and 7 patients were treated with surgery such as bypass grafting and intima resection.All patients recovered well.Conclusion Abdominal pain is the main clinical manifestation of SISMAD,but there are also some asymptomatic patients.Thrombosis,length of dissection,inlet diameter,diameter of true lumen,true lumen stenosis degree,and Yoo classification are helpful to evaluate the severity of SISMAD and guide the development of follow-up treatment plans.

关 键 词：自发性 孤立性 肠系膜上动脉夹层 临床特点 多层螺旋CT征象 预后分析 

分 类 号：R572.3[医药卫生—消化系统] R4[医药卫生—内科学]