自发性孤立性肠系膜上动脉夹层的CT分型和治疗策略

The diagnosis and treatment strategy of spontaneous isolated superior mesenteric artery dissection

目的:探讨多层螺旋CT血管成像在自发性孤立性肠系膜上动脉夹层(SISMAD)患者中的诊断价值以及不同分型的自发性孤立性肠系膜上动脉夹层的治疗策略。方法:回顾性分析2011-02-2014-01收治的12例SISMAD患者的临床资料及随访,根据CTA及DSA进行分型,探讨各型夹层的治疗方法及预后。结果:12例患者中,6例保守治疗成功,6例行介入治疗。手术患者未出现并发症,所有患者均在出院前腹痛消失。结论:CTA能直观显示SISMAD的位置,长度及病变程度,可作为诊断及随访本病的无创、准确及快速的检查方法。血管介入技术能够迅速解除夹层对动脉血流的影响,是一种新型的微创治疗方法。

Objective：To explore the diagnostic value of multislice spiral computed tomography angiography（MSCTA）and the therapeutic strategies of the different types in spontaneous isolated superior mesenteric artery dissection（SISMAD）.Method：The clinical data and long-term follow-up of twelve patients diagnosed as SISMAD during the period from Feb.2011 to Jan.2014 in Nanjing Hospital were retrospectively analyzed.The patients were classified into four Sakamoto types according to the results of CTA and DSA.The treatment for different type of SISMAD was discussed and the results and prognosis were analyzed.Result：Six patients received conservative treatment and six patients were treated successfully with interventional therapy.No complications were occurred.All patients were discharged with the alleviation of their abdominal pain.Conclusion：CTA could clearly displayed the position,length and the degree of the SISMAD.Interventional therapy could restore the true lumen with sufficient distal flow of superior mesenteric artery（SMA）and is a feasible and effective treatment strategy for SISMAD.