自发性孤立性肠系膜上动脉夹层的腔内支架治疗效果分析

Analysis of therapeutic effect on the spontaneous isolated superior mesenteric artery dissection with endovascular therapy

目的:探讨15例自发性孤立性肠系膜上动脉夹层(SISMAD)腔内支架治疗的临床效果。方法:回顾性分析2016年1月—2022年7月首都医科大学附属北京友谊医院收治的15例SISMAD行腔内支架治疗患者的病例资料。对患者入院时、术后第1天、第3天的白细胞计数、中性粒细胞百分比(NEUT%)和D-二聚体进行比较;对患者入院时的腹痛时间、YOO分型、肠系膜上动脉至腹主动脉的角度、保守治疗时间、手术时间、支架的类型及长度、血管的重塑率及支架的远期通畅率进行分析。符合正态分布的计量资料以均数±标准差(x±s)表示,两组间比较采用t检验;偏态分布的计量资料以M(Q_(1),Q_(3))表示。组间比较采用非参数检验;计数资料以例数和百分比(%)表示。同一变量不同时间点比较采用重复测量方差分析。结果:15例患者的白细胞、NEUT%、D-二聚体在术后第3天与入院时比较,差异具有统计学意义(P<0.05)。入院腹痛时间为24.0(15.0,78.0)h;YOO分型中的IVS型占46.7%,肠系膜上动脉-腹主动脉角度≥60°占66.7%;在腔内治疗前接受保守治疗时间为(34.0±8.6)h,介入手术平均时间为(153.0±37.8)min;支架的类型以自膨式裸支架占85%;支架长度≥60 cm占50%。所有患者随访24个月以上,血管重塑率为(89.7±9.7)%。支架的一期通畅率为91.7%。结论:自膨式薄壁支架置入处理IVS型SISMAD具有理想的血管重塑率及通畅率。

Objective:To discuss the clinical effect of endovascular treatment of 15 patients with spontaneous isolated superior mesenteric artery dissection(SISMAD).Methods:The clinical data of 15 patients with SISMAD treated with endovascular stent in Beijing Friendship Hospital Affiliated to Capital Medical University from January 2016 to July 2022 were collected and analyzed.The white blood cell,neutrophil percentage(NEUT%)and D-Dimer at admission,day 1 and day 3 after operation were analyzed and compared retrospectively.The time of abdominal pain at admission,YOO classification,angle from superior mesenteric artery to abdominal aorta(ASA),conservative treatment time,operation time,type and length of stent,vascular remodeling rate and long-term patency rate of stent were analyzed.The measurement data conforming to normal distribution was expressed as mean±standard deviation(x±s),t-test was used for comparison between the two groups.Measurement data of skewed distribution were expressed as M(Q_(1),Q_(3)),and non-parametric test was used for comparison between groups.Count data were expressed as rate or component ratio(%).The same variable was compared at different time points by repeated measurement data analysis of variance.Results:There were significant differences in white blood cell,NEUT%and D-Dimer between admission and postoperative day 3 in 15 patients.The time to admission for abdominal pain was 24.0(15.0,78.0)hours.IVS type accounted for 46.7%of YOO type,and the ASA beyond 60°accounted for 66.7%.The conservative treatment time was(34.0±8.6) hours,moreover,the operation time was(153.0±37.8) min.Besides,self-expanding bare stent accounted for 85%of the stent types,moreover,the length of the stents beyond 60 cm was 50%.All patients were followed up for more than 24 months,and the vascular remodeling rate was(89.7±9.7)%.Conclusion:Endovascular self-expanding thin-wall stent placement has better vascular remodeling rate and patency rate for patients with IVS type.