急性肠系膜上动脉栓塞的介入治疗  

Aspiration therapy for acute embolic occlusion of the superior mesenteric artery

作　　者：刘一人[1] 崔世军[1] 佟铸[1] 郭建明[1] 杨盛家[1] 谷涌泉[1] 郭连瑞[1] Yiren Liu;Shijun Cui;Zhu Tong;Jianming Guo;Shengjia Yang;Yongquan Gu;Lianrui Guo(Department of Vascular Surgery,Xuanwu Hospital,Capital University of Medical Sciences,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院血管外科,北京100053

出　　处：《中华介入放射学电子杂志》2024年第2期131-136,共6页Chinese Journal of Interventional Radiology：electronic edition

基　　金：国家重点研发计划(2021YFC2500504,2022YFC3602404)。

摘　　要：目的评价急性肠系膜上动脉栓塞介入治疗的有效性和安全性。方法回顾性分析2013年7月至2023年10月首都医科大学宣武医院收治的行介入导管血栓抽吸结合置管溶栓治疗SMA栓塞11例患者的临床资料。患者入院时均诊断急性肠系膜上动脉栓塞。胃肠外科医师通过腹膜穿刺或增强CT排除肠坏死后,患者进一步接受血管外科的介入治疗。评估介入治疗的并发症、有效性、安全性。结果所有患者年龄47~84(69.27±10.71)岁,其中男性8例(72.73%)。所有患者通过介入手术,即经皮穿刺行导管血栓抽吸并部分患者置管溶栓术,结合抗凝治疗。术后造影发现9例患者肠系膜上动脉主干完全通畅,2例患者存在部分缺损填充。住院死亡率为0%。12个月生存率为100%。所有患者均存活,11例患者中有2例患者在血栓抽吸过程中栓子脱落,由于空肠、回肠分支的侧支血流良好,脱落的血栓没有导致肠道缺血。结论介入抽吸血栓结合置管溶栓治疗急性肠系膜上动脉栓塞是可行的、安全的。Objective To evaluate the complications,feasibility,effectiveness,and safety of endovascular treatment for the acute embolic occlusion of the SMA.Methods This retrospective study reviewed eleven patients(eight males and three females)from July 2013 to October 2023 at Xuanwu Hospital,Capital Medical University.The patients presented with acute embolic occlusion of the SMA on admission and were initially diagnosed by computed tomography angiography(CTA).The patients who underwent endovascular treatment with a guiding catheter had no obvious evidence of bowel infarct.No intestinal necrosis was identified by gastrointestinal surgeons through peritoneal puncture or CTA.The complications,feasibility,effectiveness,safety,and mortality were assessed.Results Eight(72.73%)patients were male,and the mean patient age was 69.27±10.71 years(range,47~84 years).All patients had undertaken anticoagulation primarily,and percutaneous aspiration using a guiding catheter was then undertaken because the emboli had large amounts of thrombus residue.Complete patency of the suffering artery trunk was achieved in nine patients,and defect filling was accomplished in two patients.The in-hospital mortality was 0%.The overall 12-mo survival rate was 100%.All patients survived,and two of the eleven patients had complications(the clot broke off during aspiration).Conclusion Aspiration therapy combined with catheter-directed thrombolysis is feasible,safe,and beneficial for acute embolic SMA occlusion.Aspiration therapy has many benefits for reducing patients'death,resolving thrombi,and improving symptoms.

关 键 词：肠系膜上动脉 急性栓塞 血栓抽吸 溶栓 介入治疗 

分 类 号：R657.2[医药卫生—外科学]