自发性孤立性肠系膜上动脉夹层29例诊治分析

Diagnosis and treatment of spontaneous isolated superior mesenteric artery dissection:a report of 29 cases

目的分析自发性孤立性肠系膜上动脉夹层(spontaneous isolated superior mesenteric artery dissection,SISMAD)的诊治过程,并总结不同治疗方法的适用范围。方法回顾性分析襄阳市中心医院血管外科2017年10月至2019年12月收治的29例SISMAD病人的临床资料和治疗过程。结果所有病人先行保守治疗。其中23例病人腹痛缓解,定义为保守治疗成功组。6例病人保守治疗效果不佳转行腔内治疗,术后腹痛好转,定义为腔内治疗组。两组间在夹层长度和真腔狭窄度方面差异有统计学意义。出院后随访5~28个月,1例腔内治疗病人出现腹部隐痛不适,复查CT血管造影(CTA)提示支架通畅,支架周围侧支稍减少。其余病人随访期间无腹痛等慢性肠缺血表现。结论急诊科行CTA检查在该疾病的早期确诊中发挥着重要作用,大部分病人经保守治疗能够取得良好效果,可作为首选的治疗方案,腔内治疗可作为重要的补充手段,如出现肠坏死或夹层动脉瘤破裂出血需行开放手术治疗。

Objective To analyze the diagnosis and treatment of spontaneous isolated superior mesenteric artery dissection(SISMAD),and summarize the applicable range of different treatment methods.Methods The clinical data and the treatment process of 29 patients with SISMAD admitted to vascular surgery department of Xiangyang Central Hospital from October 2017 to December 2019 were retrospectively analyzed.Results All patients received conservative treatment initially.Abdominal pain was relieved in 23 patients,defined as the successful conservative treatment group.Six patients with poor response to conservative treatment were converted to endovascular treatment,and postoperative abdominal pain improved and were defined as the endovascular treatment group.There were significant differences between the two groups in terms of dissection length and true lumen stenosis.The patients were followed up for 5-28 months after discharge.One patient with endovascular treatment had abdominal dull pain and discomfort.Reexamination of CTA showed that the stent was unobstructed and the side branches around the stent were slightly reduced.The other patients had no chronic intestinal ischemia such as abdominal pain during follow-up.Conclusion The examination of CTA in the emergency department plays an important role in the early diagnosis of the SISMAD.Most patients can achieve good results through conservative treatment,and Conservative treatment can be used as the first choice.Endovascular treatment can be used as an important supplementary means.Open surgical treatment is required if there is bowel necrosis or the rupture of dissection aneurysm.