124例自发性孤立性肠系膜上动脉夹层的诊治经验与体会

Experience of diagnosis and treatment of 124 patients with spontaneous isolated superior mesenteric artery dissection

目的总结自发性孤立性肠系膜上动脉夹层(SISMAD)的疾病临床特点及治疗方法及预后,并对药物保守治疗及腔内治疗的近中期疗效进行比较分析。方法收集2007年12月至2017年12月住院治疗的SISMAD患者的一般临床资料及治疗选择、随访资料并进行回顾性的分析。结果本组共纳入124例SISMAD患者,主要症状为突发腹痛,影像学分型以YUN分型Ⅱ型为主。保守治疗的近期有效率为80.73%,随访症状缓解率为90.9%;腔内治疗近期有效率为96.59%,随访症状缓解率96.55%。保守治疗及腔内治疗近中期疗效均无统计学差异(P>0.05)。结论对于多数SISMAD患者,保守治疗安全有效,应为其首选治疗方式;腔内治疗提供了较好的近中期疗效,但应严格把握其适应证;在合并腹膜炎体征患者,应尽早手术治疗以期改善其预后。

Objective To summarize the clinical characteristics, treatment methods and prognosis of spontaneous isolated superior mesenteric artery dissection(SISMAD), and to compare the short-term and mid-term efficacy between conservative and endovascular treatment. Methods The general clinical data,treatment options, prognosis, and follow-up data of spontaneous isolated superior mesenteric artery dissection patients hospitalized in our department from December 2007 to December 2017 were collected and analyzed retrospectively. Results A total of 124 SISMAD patients were included in the study. The main symptoms were sudden abdominal pain. The most imaging type was YUN type II. The effective rate of conservative treatment was 80.73%, The follow-up symptom remission rate was 90.9%. The effective rate of endovascular treatment was 96.59%. The follow-up symptom remission rate was 96.55%. The short and mid-term efficacy between conservative treatment and endovascular treatment has no statically significant difference(P>0.05).Conclusion For most SISMAD patients, conservative treatment is safe and effective, and should be the first choice for treatment. Endovascular treatment provides good near-term and mid-term efficacy. However, its indications should be strictly controlled. In patients with signs of peritonitis, early surgical treatment may be reasonable.