症状性自发孤立性肠系膜动脉夹层诊疗策略

Strategies of diagnosis and treatment of symptomatic spontaneous isolated superior mesenteric artery dissection

目的探讨症状性自发性孤立性肠系膜动脉夹层(SSIMAD)的诊疗策略。方法回顾性分析44例SSIMAD患者,分析诊治过程及随访效果。结果 44例SSIMAD中,39例以腹痛为首发症状,27例伴恶心、呕吐;其中28例接受非手术治疗(抗栓+对症治疗),13例接受腔内介入治疗,3例接受开放手术。2例非手术治疗、1例手术治疗者失访。41例完成随访,平均随访时间(32.42±6.67)个月;26例非手术治疗后患者中,积极重塑21例、消极重塑5例;15例腔内介入治疗或手术治疗后患者中,积极重塑10例、消极重塑5例。结论对于急性期SSIMAD,非手术治疗仍为一线治疗方案;如非手术治疗(≥7天)不能缓解持续性腹痛症状,建议给予腔内干预;出现腹膜炎时,则应及时进行开放手术。

Objective To explore the strategies of diagnosis and treatment of symptomatic spontaneous isolated mesenteric artery dissection(SSIMAD).Methods Data of 44 patients with SSIMAD were retrospectively reviewed,and the strategies of diagnosis and treatment as well as follow-up results were analyzed.Results Among 44 SSIMAD patients,abdominal pain was the initial symptoms in 39 cases,accompanied by nausea and vomiting in 27 cases.Twenty-eight patients underwent nonsurgical treatment(antithrombotic therapy and expectant treatment), while 13 underwent intraluminal interventional therapy and 3 underwent open surgery.Two cases after nonsurgical treatments and 1 case after surgery were lost.Totally 41 patients were followed up for(32.42±6.67)months.During follow up periods,positive remodeling and negative remodeling were observed in 21 and 5 cases among 25 patients after nonsurgical treatment,while in10 and 5 cases among 15 patients after intraluminal interventional therapy or open surgery.Conclusion For acute stage SSIMAD,nonsurgical treatment should be the first-line regimen.Endovascular intervention is safe and feasible if conservative management(≥7 days)fails to relieve persistent abdominal pain symptoms.When peritonitis is present,surgical treatment should be promptly performed.