孤立性肠系膜上动脉夹层20例治疗分析

Analysis and treatment for 20 cases of isolated superior mesenteric artery dissection

目的探讨孤立性肠系膜上动脉夹层(ISMAD)疾病的临床特点及治疗经验。方法选择2014年1月—2018年1月本院血管外科收治的20例ISMAD患者的临床资料,并回顾性分析其治疗方法和疗效。结果 20例ISMAD患者,均行CTA明确诊断。其中15例经过保守治疗,12例患者症状明显缓解。5例经血管腔内治疗患者,4例成功植入裸支架,位置理想。术后造影见支架内假腔封闭,真腔及侧枝血流通畅。14例患者随访6至48个月,平均随访26个月,保守治疗的患者复查CTA随访未见夹层瘤样扩张。4例支架置入病人复查CTA均显示支架内血流通畅,假腔闭合。结论对于ISMAD行CTA检查的意义重大。大多数ISMAD患者经保守治疗能获得良好效果,少部分患者需行血管腔内治疗取得良好效果。

Objective To investigate the clinical characteristics and treatment experience of isolated superior mesenteric artery dissection( ISMAD).Methods Collected the clinical data of 20 patients with ISMAD,they were treated in the department of vascular surgery of the first affiliated hospital of Bengbu Medical College during January 2014 and January 2018,retrospectively analyzed the treatment method and efficacy. Results 20 cases of ISMAD were diagnosed by CTA.Among them,15 cases were treated with conservative therapy,in which 12 cases were relieved obviously. 5 cases were treated by endovascular therapy,in which 4 cases were successfully implanted with bare stents,and the position was ideal.After operation,false lumen occlusion was found in the stent.14 patients were followed up for 6 to 48 months,with an average follow-up of 26 months.The follow-up of CTA in conservative patients showed that there was no dissection tumor-like dilatation. In 4 cases of patients with stent implantation,CTA showed that the blood flow in the stent was smooth and the false cavity was closed.Conclusions It is of great significance for CTA examination in ISMAD.Most patients with ISMAD could get good results after conservative treatment,and a few patients need endovascular therapy to achieve good results.