Riolan动脉弓与真腔闭塞型肠系膜上动脉夹层临床预后关系观察分析

Observation and analysis of the relationship between arch of Riolan and the prognosis of superior mesenteric artery dissection with totally true lumen occlusion

目的探讨真腔闭塞型肠系膜上动脉夹层(SMAD)临床特点及预后与影像学特征之间的关系,为筛选高危患者及制定个体化治疗方案提供依据。方法收集2012年1月至2018年1月江苏省苏北人民医院血管外科收治的23例症状性真腔完全闭塞型SMAD患者病例资料,回顾性分析其病情特点,临床预后、转归及影像学变化之间的关系。结果23例真腔闭塞型SMAD患者中22例(95.65%)经保守治疗后腹痛症状好转,平均缓解时间为(3.96±1.61)d。1例患者在入院时即出现血便伴腹膜炎体征,接受急诊手术治疗。保守治疗患者中入院时即可见明显Riolan动脉弓形成者(13例)疼痛评分及腹痛缓解时间均明显低于无动脉弓形成者(9例)。术后平均随访时间(78.83±15.90)个月,仅1例再次出现腹痛,再次保守治疗后好转。随访期间12例患者真腔再通,其中4例Riolan动脉弓开放;11例真腔仍闭塞,但可见明显侧支循环代偿,其中9例可见Riolan动脉弓。结论Riolan动脉弓及其他侧支血管的早期建立有助于改善真腔闭塞型SMAD患者症状,对于避免肠道缺血坏死有一定意义。

Objective To explore the relationship between the clinical and imaging features of superior mesenteric artery dissection(SMAD)with totally true lumen occlusion and its prognosis,and provide evidence for screening high-risk patients and making individualized treatment.Methods The data of symptomatic SMAD patients with totally true lumen occlusion admitted to the Department of Vascular Surgery of Subei People’s Hospital from January 2012 to January 2018 were collected,and the relationship between the disease characteristics,clinical prognosis,outcome and imaging changes was retrospectively analyzed.Results Among the 23 patients,22(95.65%)were relieved from symptoms after conservative treatment,with an average relief time of(3.96±1.61)days.One patient suffered from bloody stool,abdominal pain and abdominal distension at admission and received emergency surgery.However,it was observed that the pain score and abdominal pain relief time of 13 patients with obvious arch of Riolan formation were significantly lower than the 9 patients without obvious arch of Riolan upon admission.The average follow-up time was(78.83±15.90)months.During the follow-up period,recurrence of abdominal pain was observed in only one patient,and was alleviated after conservative treatment.CTA revealed recanalization of the true lumen in 12 patients(arch of Riolan was visible in 9 cases)and complete occlusion of the true lumen in 11 patients.However,significantly collateral circulation compensation was observed in the patients with true lumen occlusion,and arch of Riolan was visible in 9 cases.Conclusion The establishment of arch of Riolan and other collateral vessels can contribute to alleviate the symptoms and avoid intestinal ischemic necrosis in SMAD patients with totally true lumen occlusion.