孤立性肠系膜上动脉夹层:CT征象与临床治疗及预后相关性的分析

Isolated dissection of superior mesenteric artery:correlations between computed tomography features and treatment and prognosis

目的研究孤立性肠系膜上动脉夹层的CT征象与临床治疗及预后的相关性。方法回顾性收集2012年1月至2017年12月中山大学附属第一医院诊断的孤立性肠系膜上动脉夹层的病历资料及CT影像结果。研究其CT特征与临床症状及治疗方法的相关性。回顾复查CT影像并进行电话随访。结果64例孤立性肠系膜上动脉夹层患者,包括40例有症状患者和24例无症状患者。有症状组夹层长度较无症状组长,两组比较差异有统计学意义[(62.2±31.9)mm比(33.3±15.6)mm,P<0.001],有症状组真腔直径及真腔残留率较无症状组小,两组比较差异有统计学意义[(3.3±1.5)mm比(4.2±1.8)mm,P=0.044;(36.1±29.4)%比(48.7±21.3)%,P=0.046]。51例患者接受保守治疗,46例疗效良好。结论孤立性肠系膜上动脉夹层的临床症状与夹层长度及真腔狭窄度有相关性,保守治疗可作为主要治疗方法。

ObjectiveTo study the correlation between computed tomography (CT) features and clinical presentation and management in isolated dissection of superior mesenteric artery dissection (IDSMA).MethodsWe retrospectively analyzed the clinical records and CT findings of the patients with IDSMA from 2012 to 2016. The relationship between CT features and clinical symptom and therapeutic strategy in these patients were investigated. In addition, the data of CT scans and telephone interviews during follow-up were reviewed as well.ResultsA total of 64 patients with IDSMA were evaluated, including 40 symptomatic and 24 asymptomatic patients. Compared with the asymptomatic group, the symptomatic group had a longer dissection [(62.2±31.9)mm vs (33.3±15.6)mm, P<0.001], a smaller diameter of true lumen [(3.3±1.5)mm vs (4.2±1.8) mm, P=0.044] and a smaller true lumen residual diameter [(36.1±29.4)% vs (48.7±21.3)%, P=0.046). Fifty-one patients were treated conservatively, of which 46 achieved clinical improvement.ConclusionsIn IDSMA, clinical symptom is related to the length of dissection and the stenosis of the true lumen. Conservative treatment is commonly provided with beneficial outcome.