薄壁裸支架治疗自发孤立性肠系膜上动脉夹层32例临床分析

The efficacy of thin struct bare stents for the treatment of spontaneous isolated dissection of the superior mesenteric artery

目的:探讨薄壁裸支架治疗自发孤立性肠系膜上动脉夹层(SIDSMA)的有效性。方法:回顾性分析2016年1月至2021年1月在嘉兴市第一医院血管外科(20例)和东部战区总医院普通外科(12例)使用薄壁裸支架治疗的SIDSMA患者的资料。男性27例,女性5例,年龄(54.8±9.4)岁(范围:36~75岁)。病变处植入薄壁裸支架,夹层显影仍较明显者行假腔弹簧圈栓塞。观察患者术后症状改善情况,记录随访期间病变部位血管重塑和支架通畅情况。结果:手术成功率100%。共植入支架51枚,植入1枚17例,2枚11例,3枚4例。32例支架植入后造影显示支架内血流通畅,2例患者加行假腔弹簧圈栓塞,造影示假腔填塞完全。术前腹痛数字评分为(6.1±1.5)分(范围:4~10分),术后1 h降为1.0(1.0)分(范围:0~3分)(W=528,P<0.01)。术前肠系膜上动脉真腔受压程度为(92.3±6.7)%(范围:25%~94%),术后1个月降为0.8(1.2)%(范围:0~3.2%)(W=528,P<0.01)。术后1个月CT血管造影示支架内血流通畅,血管重塑率为(92.3±6.7)%(范围:80%~100%)。术后随访(46.3±17.0)个月(范围:24~76个月),未出现肠道缺血症状,1、2和5年累积一期通畅率均为100%。结论:薄壁裸支架腔内治疗SIDSMA创伤较小,远期效果较满意。

Objective To examine the effectiveness of thin struct bare stents for the treatment of spontaneous isolated dissection of the superior mesenteric artery(SIDSMA).Methods The data of 32 patients admitted to First Hospital of Jiaxing(20 cases)and Jinling Hospital(12 cases)with SIDSMA from January 2016 to January 2021 were retrospectively analyzed.There were 27 males and 5 females,aging(54.8±9.4)years(range:36 to 75 years).All patients were treated with thin struct bare stents.Controllable spring coils were used to fulfill the false lumen in 2 cases.Symptoms,vascular remodeling pattern at the SIDSMA lesion,and patency of the stents were observed during follow-up.Results The surgical success rate was 100%.According to the length of the lesions and stents,the number of stents implanted was 1 in 17 cases,2 in 11 cases and 3 in 4 cases.The angiography showed that blood flow in the stent was smooth.The numerical rating scale for abdominal pain decreased from 6.1±1.5(range:4 to 10)preoperatively to 1.0(1.0)(range:0 to 3)1 hour postoperatively(W=528,P<0.01).The compression rate of the true lumen of the superior mesenteric artery decreased from(92.3±6.7)%(range:25%to 94%)preoperatively to 0.8(1.2)%(range:0 to 3.2%)1 month postoperatively(W=528,P<0.01).The primary patency rate of CT angiography at 1 month postoperatively was 100%.The vascular remodeling rate was(92.3±6.7)%(range:80%to 100%).All patients were followed for(46.3±17.0)months(range:24 to 76 months).The cumulative patency rates in 1,2 and 5 years were all 100%.Conclusion The use of thin struct bare stents for SIDSMA could obtained the expected safety and efficacy.