自发性孤立性肠系膜上动脉夹层的诊疗分析

Diagnosis and treatment of spontaneous isolated superior mesenteric artery dissection

目的 分析自发性孤立性肠系膜上动脉夹层（SISMAD）的影像学表现、治疗方案及预后。方法 回顾性分析25例SISMAD患者的资料，分析其影像学特征、分型、治疗方法及随访记录。结果 25例患者中，Ⅰ型3例，Ⅱa型14例，Ⅱb型7例，Ⅲ型1例。2例无腹痛症状的患者，CTA分型为Ⅰ型，给予观察治疗。23例有症状的患者，保守治疗4例，其中Ⅱa型1例，Ⅱb型3例；血管腔内治疗18例，其中Ⅱa型13例，Ⅱb型4例，Ⅲ型1例；另有1例Ⅰ型患者经保守治疗后腹痛不缓解，复查CTA示假腔持续扩大，后转血管腔内治疗。随访时间1~43个月，中位随访时间8个月，随访期间患者均未出现腹痛等症状，CTA提示病变无进展，支架无移位并保持通畅。结论 SISMAD临床症状缺乏特异性，CTA可明确诊断并进行影像学分型，结合患者的症状，可指导临床治疗方案的制定。

Objective To analyze the imaging findings, treatment and prognosis of the patients with spontaneous isolated superior mesenteric artery dissection （SISMAD）. Methods Clinical presentation, imaging appearances, classification, treatment and follow-up of 25 SISMAD patients were retrospectively analyzed. Results In all 25 patients, SISMAD was categorized into the following three types based on imaging appearances： Three cases were classified as type Ⅰ, 14 cases were classified as Ⅱa, 7 cases were classified as Ⅱb type and 1 case was classified as type Ⅲ. Two patients without the symptom of abdominal pain, whose classification were type Ⅰ, received the observation treatment. Four of the 23 patients who had clinical symptoms received conservative treatment, 1 of which were classified as type Ⅱa and 3 of which was classified as type Ⅱb; eighteen of the 23 patients who had clinical symptoms received endovascular treatment, including 13 cases of type Ⅱa, 4 cases of type Ⅱb and 1 case of type Ⅲ; another 1 case of type Ⅰ patients, whose abdominal pain was not relieved after conservative treatment, received endovascular treatment subsequently. The patients were followed up for 1—43 months, the median follow-up time was 8 months. There was no abdominal pain or other symptoms during the follow-up period. CTA imaging suggested that the lesions had no progress, and stents kept open and non-displaced. Conclusion The clinical symptoms of SISMAD are not specific. CTA can definite diagnosis and make classification. Combining with the severity of clinical symptoms, CTA can guide the clinical treatment strategy.