自发性孤立性肠系膜上动脉夹层的诊断及腔内支架治疗

Diagnosis and endovascular stent graft treatment of spontaneous isolated superior mesenteric artery dissection

目的：探讨自发性孤立性肠系膜上动脉夹层（SIDSMA）的诊断及治疗策略。方法：回顾分析2008—2010年期间15例接受血管腔内支架治疗的SIDSMA患者的临床资料。结果：15例均未合并夹层破裂出血或肠坏死。其中,12例行单层支架释放,3例行重叠支架释放,共释放支架18个（球扩式2个,自膨式16个）。术后及随访过程中,症状改善14例（93.3%）,症状无变化1例（6.7%）,无死亡,无肠坏死、腹腔出血、心肌梗死、脑血管意外、肾功能衰竭、消化道出血、肺炎等严重并发症发生。平均住院4（2~7）d。平均随访时间11（6~23）个月。15例患者术后6个月均行CTA复查,支架通畅率为100%,支架远端新发夹层1例（6.7%）。结论：对于未合并夹层破裂出血、肠坏死的SIDSMA患者,腔内支架治疗是一种安全、有效、微创的治疗选择。

Objective： To investigate the diagnosis and treatment strategy of spontaneous isolated dissection of the superior mesenteric artery （SIDSMA）. Methods： The clinical data of 15 patients with SIDSMA undergoing endovascular stent placement from January 2008 to December 2010 were retrospectively analyzed. Results： None of the 15 patients had complication of rupture/hemorrhage of the dissection or bowel infarction. Of the patients, single layer stents were deployed in 12 cases, and overlapping stents were deployed in 3 cases. A total of 18 stents （2 balloon expandable stents and 16 self-expandable stents） were deployed. Fourteen （93.3%） patients had relief of symptoms, one （6.7%） patient＇s symptoms remained unchanged, and no death or severe complications such as intestinal infarction, abdominal bleeding, cardiac infarction, cerebrovascular accident, renal failure, gastrointestinal tract hemorrhage or pneumonia occurred after operation or during follow-up. The average length of hospital stay and follow-up was 3 d （2-7 d） and 11 months （6-23 months）, respectively. All of the 1S patients underwent CTA examination 6 months later, and the results showed that the stent patency rate was distal to the stent. 100% and one （6.7%） patient developed a new dissection Conclusion： For SIDSMA patients without rupture/hemorrhage or bowel infarction, endovascular stent placement is a feasible, minimally invasive and effective treatment option.