急性肠系膜上动脉血栓形成的腔内溶栓治疗:附24例报告

Catheter-directed thrombolysis for acute superior mesenteric artery thrombosis: a report of 24 cases

目的:探讨急性肠系膜上动脉血栓形成(ASMAT)行腔内导管接触溶栓(CDT)治疗的有效性和安全性。方法:回顾性分析2012年1月—2017年2月中国人民解放军第九七〇医院应用CDT治疗24例ASMAT患者的临床资料。结果: 24例患者中男14例,女10例;平均年龄为(68.6±11.2)岁;发病到就诊平均时间为(8.2±3.4)h。所有患者均实施CDT或CDT联合其他腔内治疗,CDT平均时间(42.8±8.3)h。治愈18例(75.0%,18/24),包括发病6 h以内的10例,发病时间为6~12 h的8例,其中单纯CDT 14例,CDT+经皮血管腔内成形术(PTA)2例,CDT+PTA+支架置入2例。有效4例(16.7%,4/24),包括发病时间为6~12 h的3例,发病时间为20 h的1例,均施行CDT+PTA治疗。无效2例(8.3%,2/24),发病时间分别为9 h和19 h,其中1例在CDT溶栓治疗30 h后出现腹膜刺激征,行肠切除+肠吻合术,切除小肠长度为150.0 cm,术后腹痛症状消失,恢复良好;另1例在CDT治疗10 h后出现腹膜刺激征,行肠切除+肠吻合术,剩余小肠约200 cm,出现短肠综合征,术后第7天死于心肌梗死。23例获随访(43±17)个月,无复发及加重情况;1例支架植入术后患者复查CTA提示支架内再狭窄,程度约50%,因无临床症状未行治疗。结论: CDT在ASMAT的治疗中安全、有效、微创。

Objective: To investigate the effectiveness and safety of catheter-directed thrombolysis (CDT) in treatment of acute superior mesenteric artery thrombosis (ASMAT). Methods: The clinical data of 24 patients with ASMAT undergoing CDT from January 2012 to February 2017 were retrospectively analyzed. Results: Of the 24 patients, 14 cases were males and 10 cases were females, with an average age of (68.6±11.2) years;the average time from onset to consultation was (8.2±3.4) h. All patients underwent CDT or CDT plus other endovascular procedures, with an average time of (42.8±8.3) h for CDT. Eighteen patients (75.0%, 18/24) were cured, of whom, the onset time was less than 6 h in 10 cases and 6-12 h in 8 cases;14 cases underwent CDT alone, 2 cases underwent CDT plus percutaneous transluminal angioplasty (PTA), and 2 cases underwent CDT plus PTA and stent implantation. Four patients (16.7%, 4/24) were improved, of whom, the onset time was 6-12 h in 3 cases and 20 h in 1 case;all underwent CDT plus PTA. Treatment failed in 2 patients (8.3%, 2/24), of whom, the onset time was 9 and 19 h respectively;1 case showed peritoneal irritation signs 30 h after CDT, then underwent bowel resection and anastomosis with approximately 150.0 cm of small bowel resected, and after that, the abdominal symptoms disappeared and the postoperative recovery was satisfactory, while the other case showed peritoneal irritation signs 10 h after CDT, then underwent bowel resection and anastomosis, but the remnant small bowel was only about 200 cm in length and after that, short bowel syndrome occurred and the patient died of myocardial infarction on the 7th day after operation. Twenty-three patients were followed up for (43±17) months, no recurrence and aggravation occurred;CTA showed about 50% stenosis within the stent in 1 case with stent implantation, for which no treatment was given because of no clinical symptoms. Conclusion: CDT is a safe, effective and minimally invasive method in treatment of ASMAT.