急性自发性孤立性内脏动脉夹层性腹痛在急诊科的诊疗分析

Diagnosis and treatment of acute spontaneous isolated visceral artery dissection abdominal pain in emergency department

目的:探讨急性自发性孤立性内脏动脉夹层(AVAD)性腹痛在急诊科的发病特点及诊治策略。方法:回顾性分析我院诊治的21例AVAD患者资料,分析其临床特点、诊治过程。结果:21例患者中肠系膜上动脉夹层(SMAD)16例,腹腔动脉夹层(CAD)5例,其中19例表现为腹痛。根据SMAD的Yun分型,Ⅰ型5例,Ⅱa型5例,Ⅱb型3例,Ⅲ型3例。SMAD中第1破口距起始部平均距离为36mm,夹层的平均长度为55mm,CAD中第1破口距起始部平均距离为12mm,夹层的平均长度为9mm。15例保守治疗3~9d后腹痛症状逐渐缓解或消失;1例CAD行弹簧圈栓塞术,1例SMAD行弹簧圈栓塞术,2例SMAD行腔内支架治疗,1例SMAD行置管溶栓加罂粟碱灌注术,1例SMAD行肠系膜上动脉取栓加小肠切除术。因腹痛不适首次就诊于急诊科的有17例,11例被误诊或漏诊。结论:AVAD在临床工作中并不少见,临床医师应该提高对本病的认识,抓住最佳治疗时间,结合影像学及临床表现制定个体化治疗方案。保守治疗对绝大多数AVAD是有效的,若保守治疗失败可进一步选择腔内治疗或开放手术治疗。

Objective：To investigate the characteristics,diagnosis and treatment of acute spontaneous isolated visceral artery dissection（AVAD）.Method：The clinical features,diagnosis and treatment of the 21 cases of AVAD were analyzed retrospectively in our hospital.Result：Sixteen cases were SMAD,5 were CAD,and 19 were abdominal pain in the 21 patients,16 patients were classified according to Yun of SMAD,of which type I 5 people,type IIa5 people,type IIb 3 people and type III 3 people.The average distance of the first break from the anterior mesenteric artery was 36 mm and the average length of the dissection was 55 mm,the average distance of the first break from the anterior celiac artery was 12 mm and the average length of the dissection was 9 mm.Fifteen cases of conservative treatment 3~9 dafter abdominal pain symptoms were relieved or disappeared.1 case underwent coil embolization SMAD and the same as CAD.Two cases underwent bare stent implantation.One case underwent thrombolysis plus papaverine infusion.One case underwent embolization and small bowel resection.There were 17 cases who visited to the emergency department due to the first abdominal pain,however,11 cases were misdiagnosed or missed.Conclusion：AVAD is not uncommon in clinical work.Clinicians should improve their understanding of the disease,seize the best time to treatment,and formulate individualized plans combining the imaging and the clinical manifestations.Conservative treatment is effective for most AVAD.If it fails,endovascular treatment or open surgery can be further selected.