21例自发性孤立性肠系膜上动脉夹层临床诊治分析

Clinical diagnosis and treatment analysis of 21 cases of spontaneous isolated superior mesenteric artery dissection

目的 总结自发性孤立性肠系膜上动脉夹层(SISMAD)诊断和治疗方法。方法 收集2018年1月至2022年12月潍坊市益都中心医院收治的21例SISMAD患者的临床资料,观察患者腹痛、进食改善情况,分析肠系膜上动脉自我塑形及支架有无狭窄、通畅状况。结果 19例SISMAD患者经计算机断层扫描血管成像(CTA)检查明确诊断,1例行彩色多普勒超声检查明确诊断,1例行剖腹探查明确诊断。15例患者行保守治疗后腹痛缓解,2例患者经保守治疗效果不佳后行支架置入治疗后腹痛缓解,1例患者行单纯球囊扩张治疗腹痛缓解,1例患者术中无法分辨真假腔行单纯导丝疏通后腹痛缓解,1例患者出现空肠穿孔行修补治疗,1例患者出现小肠坏死行部分肠切除治疗,术后均腹痛缓解。20例患者随访6~12个月,1例患者出院后失访,随访20例患者腹痛症状均缓解,进食状况明显改善。结论 SISMAD的临床表现、影像学特征及转归多变,单一影像学检查及治疗措施无法覆盖所有患者,需以CTA检查及抗凝治疗为主,并结合其他诊疗措施进行个体化治疗,才能够对SISMAD提供更加优化的诊疗措施。

Objective To summarize the diagnosis and treatment of spontaneous isolated superior mesenteric artery dissection(SISMAD).Method Clinical data of 21 SISMAD patients admitted to Weifang Yidu Central Hospital from January 2018 to December 2022 were collected,abdominal pain and improvement in eating were observed,the self-shaping of superior mesenteric artery and stent stenosis and patency were analyzed.Result The diagnosis of 19 SISMAD patients were confirmed by computed tomography angiography(CTA),1 patient with SISMAD was confirmed by color Doppler ultrasonography,and 1 patient with SISMAD was confirmed by exploratory laparotomy.Fifteen patients received conservative treatment and their abdominal pain improved.Two patients received stent placement after poor conservative treatment.One patient received simple balloon dilation for abdominal pain relief.One patient was unable to distinguish between true and false cavities during surgery and underwent simple guidewire unblocking for abdominal pain relief.One patient developed a jejunal perforation for repair treatment.One patient developed small intestine necrosis and underwent partial intestinal resection treatment.All patients experienced relief of abdominal pain after surgery.Twenty patients were followed up for 6 to 12 months,and 1 patient was lost to follow-up after discharge.All the 20 patients were relieved of abdominal pain symptoms and their eating status were significantly improved.Conclusion The clinical manifestations,imaging features,and outcomes of SISMAD are variable,the single imaging examination and treatment cannot cover all patients,so it is necessary to focus on CTA examination and anticoagulation therapy,combined with other diagnostic and treatment measures to provide more optimized diagnostic and treatment measures for SISMAD.