经导管溶栓及支架植入术治疗肠系膜上动脉闭塞性肠缺血

目的 评价经导管溶栓及支架植入术治疗肠系膜上动脉(SMA)闭塞性缺血的有效性.方法 14例SMA闭塞性缺血患者,男7例,女7例,年龄48～84岁(平均61.5岁),其中SMA粥样硬化性狭窄7例,SMA夹层性狭窄2例,SMA血栓性闭塞5例;表现为急性腹痛及慢性间歇性腹痛伴进食后加重各7例,其中2例伴有血便.8例SMA患者各植入1枚支架;另6例先行溶栓治疗,其中1例溶栓后植入支架.结果 经导管溶栓及支架植入术后,14例SMA均获得通畅.术后2～24 h患者腹痛均明显缓解或消失,均无并发症发生.随访2～19个月(平均12.8个月),1例于16个月死于心力衰竭,另13例未再发生肠缺血症状.结论 经导管溶栓及支架植入术是SMA闭塞性缺血安全、有效的治疗方法 .

Catheter-directed thrombolysis and stent implantation for intestinal ischemia from superior mesenteric artery occlusion

Objective To evaluate the clinical efficacy of stent implantation and catheter-directed thrombolysis for intestinal ischemia from superior mesenteric artery (SMA) stenosis or occlusion. Methods Fourteen patients with intestinal ischemia from SMA stenosis or occlusion (male 7, female 7, aged 48-84 years) were enrolled. SMA stenosis was caused by atherosclerosis in 7 cases, by dissection in 2 cases, while by thrombosis in the other 5 patients. The main symptoms included acute abdominal pain (n=7), chronic intermittent abdominal pain (n=7) and melena (n=2). Eight stents were implanted in 8 patients respectively, and catheter thrombolysis was performed in the other 6 patients, and one of them accepted stent implantation after thrombolysis. Results SMA had smooth blood flow immediately after stent implantation and catheter thrombolysis in all patients. The abdominal pain eliminated or alleviated obviously in 2-24 hours after intervention. No serious complication occurred. During the follow-up period from 2 to 19 months (mean 12.8), no intestinal ischemia symptoms reoccurred except one patient died of heart function failure at the 16th month. Conclusion Stent implantation and catheter-directed thrombolysis are safe and effective treatments for acute and chronic intestinal ischemia from SMA stenosis or occlusion.