基于CT血管造影的症状型自发性孤立性肠系膜上动脉夹层保守治疗的预后

Prognostic Tendency Based on CTA of Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection in Conservative Treatment

目的 探讨症状型自发性孤立性肠系膜上动脉夹层(SISMAD)保守治疗的转归。资料与方法 回顾性分析2016年1月—2019年12月滨州医学院附属医院和华中科技大学附属协和医院CT血管造影确诊的34例症状型SISMAD患者保守治疗的临床相关资料,分析其影像学分型、治疗结果及随访结果。结果 34例患者中,23例(67.65%)出现积极重塑,其中完全重塑6例(17.65%),积极的形态改变8例(23.53%),真腔残余直径改善9例(26.47%)。11例(32.35%)出现消极重塑,其中夹层动脉瘤形成3例(8.82%),消极形态改变4例(11.76%),真腔残余直径恶化4例(11.76%)。消极重塑组中7例保守治疗1周后腹部疼痛症状未见明显缓解转为腔内治疗。最终保守治疗成功率为79.41%(27/34)。结论 保守治疗是症状型SISMAD的一线治疗方案。大多数患者在保守治疗后预后肠系膜上动脉转归为积极重塑。

Purpose To investigate the outcome of symptomatic spontaneous isolated superior mesenteric artery dissection(SISMAD)after nonsurgical treatment.Materials and Methods The clinical data of 34 symptomatic SISMAD patients confirmed by CTA from January 2016 to December 2019 in Binzhou Medical Universty Hospital and Union Hospital,Tongji Medical College,Huazhong University of Science and Technology were retrospectively analyzed.The imaging type,treatment results and follow-up results were analyzed.Results Among 34 patients,positive remodeling occurred in 23 cases(67.65%),including complete remodeling patients 6 cases(17.65%)and positive morphological changed patients 8 cases(23.53%),and true lumen residual diameter improvement 9 cases(26.47%).Negative remodeling occurred in 11 cases(32.35%),including 3 cases(8.82%)of dissecting aneurysm formation,4 cases(11.76%)of negative morphological changes,and 4 cases(11.76%)true lumen residual diameter deterioration.In the negative remodeling group,7 patients had no significant relief of abdominal pain symptoms after one week of non-surgical treatment and were transferred to endovascular treatment.The final success rate of non-surgical treatment was 79.41%(27/34).Conclusion Nonsurgical treatment should be the first line of treatment for symptomatic SISMAD.Most patients underwent positive remodeling after non-surgical treatment.