肠系膜上动脉夹层的诊断与裸支架置入治疗

Diagnosis of Superior Mesentery Artery Dissection with MSCT Angiography and Treatment with Bare Stents Placement

目的:探讨64层螺旋CT血管成像(multislice spiral computed tomography angiography,MSCTA)在肠系膜上动脉夹层中的诊断价值及裸支架置入术的治疗效果。方法:回顾性分析5例经64层螺旋CT证实肠系膜上动脉夹层患者影像学资料特征及经裸支架置入后的治疗效果。结果:5例患者中,Ⅰ型2例,Ⅱ型1例,Ⅲ型2例。均在肠系膜上端起始部形成真假腔,真腔变细。4例动脉期为低密度影,1例动脉期为高密度影。经裸支架置入后,假腔消失,肠系膜远端血供增加。术后半年随访、MSCTA复查,患者未再出现腹痛,肠系膜上动脉显影通畅,瘤腔消失,支架无移位。结论:64层螺旋CT血管成像扫描,图像清晰,能够清楚显示肠系膜上动脉夹层的部位、长度及病变程度。裸支架置入术能够迅速解除夹层对动脉血流的影响,降低肠道因缺血而出现坏死的风险。

Objective To evaluate the diagnostic value of MSCTA and the therapeutic value of endovascular bare stents placement in superior mesenteric artery(SMA) dissection.Methods The clinical data of five patients with superior mesenteric artery dissection confirmed by MSCTA were analyzed respectively,and the effects of endovascular stents placement were evaluated.Results The five patients were classified typeⅠ(2 cases),typeⅡ(1 case) and typeⅢ(2 cases).There were true and false double lumen at the top of superior mesenteric artery,the true lumen became narrow.The MSCTA results demonstrated that 4 cases were low density in arterial phase,1 case was high density in arterial phase.After treating with endovascular bare stents placement,the fale lumen disappeared gradually and the blood supply in superior mesenteric artery dissection increased.Repeated MSCTA and following up were performed at half year after operation,the results showed that complete resolution of the dissection and successful restoration of the true lumen with sufficient distal flow of SMA were obtained in five patients.Conclusion MSCTA could clearly showed the position,length and degree of SMA.The endovascular bare stents placement could restore the true lumen with sufficient distal flow of SMA and decrease the risk of necrosis induced by ischemia.