孤立性肠系膜上动脉夹层的分型、影像诊断及其预后

The type, imaging diagnosis and prognosis of isolated superior mesenteric artery dissection

目的探讨孤立性肠系膜上动脉夹层（SMAD）的分型、影像学诊断及其预后，进一步提高对SMAD的认识。方法16例SMAD患者均行多排螺旋CT（MSCT）检查，6例行数字减影血管造影（DSA），回顾性分析临床及影像资料，总结SMAD的分型、影像学特征及其预后。结果7例可判断破裂口位置，9例为壁间血肿型。10例经内科保守治疗后病情稳定；6例伴夹层动脉瘤者中，5例经腔内支架治疗后病情稳定，1例内科保守治疗后病情稳定。MSCT平扫真假腔均表现为等密度，无法分辨真假腔，但伴夹层动脉瘤形成者可看到SMA呈“椭圆形”或“8字形”改变；动脉期假腔呈“新月形”或“环形”低密度影包绕真腔。DSA影像特征与MSCT表现一致，但可以进一步评估病情。结论孤立性SMAD的MSCT表现具有特征性，MSCT能够正确诊断SMAD；DSA不但可以确诊SMAD，同时还可以评价病变的程度、范围、是否伴有夹层动脉瘤及周围侧支循环的代偿情况，对患者的病情评估具有重要的临床意义。壁间血肿型SMAD经内科保守治疗后一般可获得良好的效果，伴夹层动脉瘤形成的患者一般需腔内治疗。

Objective To investigate the type, imaging diagnosis and prognosis of isolated superior mesenteric artery dissection （ SMAD）, and further enhance the understanding of it. Methods A retrospective analysis of 16 cases of SMAD pa- tients clinical data, imaging features and prognosis. Results 7 cases can judge the location of the rupture, 9 cases of intramu- ral hematoma. Conservative treatment in 11 cases and endovascular treatment in 5 cases with dissecting aneurysm got good cura- tive effect. MSCT plain scan could not distinguish between the true and false lumen, but the patients who with dissecting aneu- rysm could be seen SMA was in ＂oval＂ or ＂8-shaped＂ changed; arterial phase： the false lumen was in low density of ＂ new crescent＂ or ＂ring＂ surrounding the true lumen. DSA imaging features consistent with the MSCT findings, but could further as- sess the disease. Conclusion MSCT have characteristics and could diagnose isolated SMAD correctly. DSA could not only di- aguose it, but also evaluation the condition of patients. Conservative treatment in cases of intramural hematoma and endovascu- lar treatment in cases with dissecting aneurysm are efficiently.