自发性孤立性肠系膜上动脉夹层的诊治：附3例报告

目的：探讨自发性孤立性肠系膜上动脉夹层（SISMAD）的诊治策略。 方法：回顾性分析中南大学湘雅医院血管外科2012年10月—2013年5月期间收治的3例SISMAD患者的临床资料，总结SISMAD患者的临床表现和影像学特征、治疗策略的选择以及预后情况。 结果：3例SISMAD患者中男2例，女1例；临床症状均表现为腹痛，伴恶心呕吐；治疗前CTA均示肠系膜上动脉内由内膜片分割形成的真假腔，其中Sakamoto II型2例、III型1例；均未合并夹层破裂出血或肠坏死。3例均在低分子肝素钙抗凝治疗的基础上再行腔内支架治疗，术后无严重并发症发生，腹痛症状缓解。随访2~8个月，3例均存活，症状消失，支架通畅。 结论：对有症状的疑似SISMAD的患者，应行CTA检查明确诊断；未合并夹层破裂出血、肠坏死SISMAD的患者，抗凝治疗的基础上腔内支架治疗是一种安全、有效的方法。

Diagnosis and treatment of spontaneous isolated superior mesenteric artery dissection: a report of 3 cases

Objective: To investigate the diagnosis and treatment strategy of spontaneous isolated superior mesenteric artery dissection (SISMAD). Methods: The clinical data of 3 SISMAD patients treated in the Department of Vascular Surgery of Xiangya Hospital of Central South University from October 2012 to May 2013 were retrospectively analyzed. The clinical manifestations, imaging features, treatment strategy options and prognosis of the SISMAD patients were summarized. Results: Of the 3 SISMAD patients, 2 cases were male and one case was female; the clinical symptoms were abdominal pain with nausea and vomiting; pre-treatment CTA showed the formation of an intimal flap separating the true and false lumen in the superior mesenteric artery, which was identified as Sakamoto type II in 2 cases and type III in one case; no case was complicated with dissection rupture or bleeding, or intestinal necrosis. All of the 3 patients underwent initial anticoagulant therapy with low-molecular-weight heparin calcium, and then endovascular stent placement. No severe complications occurred and the abdominal pain of the patients was alleviated after treatment. Follow-up was conducted for 2 to 8 months; the 3 cases were all alive, their symptoms disappeared, and the stents were patent. Conclusion: CTA is recommended in patients suspicious for SISMAD to confirm the diagnosis, and endovascular stent placement based on anticoagulant therapy is a safe and effective treatment modality for those without dissection rupture/bleeding or intestinal necrosis.