自发性孤立性肠系膜上动脉夹层的治疗

目的:探讨自发性孤立性肠系膜上动脉夹层(SISMAD)治疗方法的选择。方法:回顾性分析2008-02-2014-01收治的29例SISMAD患者的临床资料。最初保守治疗25例,其中5例保守治疗无效后改行血管腔内治疗;急诊手术4例,均行小肠切除,其中1例行肠系膜上动脉切开取栓+内膜部分切除术,1例小肠切除前行肠系膜上动脉溶栓+支架植入术。结果:20例保守治疗有效;CTA随访显示假腔血栓部分或大部溶解(14例)或夹层无变化(2例)。血管腔内治疗获满意效果,CTA随访显示假腔消失或血栓形成,真腔通畅。4例开放手术中,1例死亡,其余3例均恢复良好。结论:大多数SISMAD保守治疗有效,若腹痛持续或加重,应适时中止保守治疗,改行腔内治疗;外科手术适合于夹层所致肠缺血坏死或动脉瘤破裂。

Treatment of spontaneous isolated of superior mesenteric artery dissection

Objective：To explore the therapeutic option of spontaneous isolated of superior mesenteric artery dissection （SISMAD）. Method： 29 patients with SISMAD admitted in our hospital from Feb. 2008 to Jan. 2014 were retrospectively analyzed. Conservative treatment was initially carried out in 25 patients. Among them, 5 pa- tients received endovascular therapy due to ineffective conservative treatment. 4 patients underwent urgent surgery because of small bowel ischemia. Among them,2 patients received thrombectomy plus intimectomy,and bare stent placement before open-surgery, respectively. Result：The symptoms were totally under control without recurrence during the follow-up period of 1--46 months by conservative treatment in 20 cases. CTA demonstrated diminished extent and length of dissection or completed remodeling of dissection in 14 cases, no change of dissection in 2 ca- ses. The good results were seen in 5 cases following endovascular therapy at a median follow-up of 11.8 months. CTA showed disappeared or thrombosed false lumen with the patency of true lumen. Among 4 patients with sur- gery,one was died of multiple organ failure. The remaining 3 patients were well recovered after operation. Conclu- sion：Conservative treatment is effective for most of patients with SISMAD. Endovascular therapy should be recom- mended for the patients with persistent abdominal symptoms or progressing of dissection by conservative treat- ment. Surgery is mainly indicated for the patients related to intestinal ischemia or rupture of aneurysm.