CAJ | 학술논문

目的比较支架置入与药物溶栓治疗急性肠系膜上动脉缺血的近、中期疗效.方法收集2004年1月至2008年12月,中国医科大学附属第一医院因肠系膜上动脉狭窄或闭塞引起急性肠缺血住院患者35例.其中,支架置入12例(介入治疗组),外周药物溶栓23例(药物溶栓组).介入治疗组采用球囊扩张及支架置入并辅以抗凝、祛聚及扩血管治疗,药物溶栓组采用尿激酶配合抗凝、祛聚及扩血管治疗.两组患者出院后均口服氯吡格雷及阿司匹林并进行随访.用Fisher确切概率法比较分析两组疗效差异的显著性.结果药物溶栓组临床有效7例,无效16例(加重或死亡7例,治疗失败行部分肠切除9例).介入治疗组10例置入支架(1例术后第3天死于急性心肌梗死),2例开通失败.随访1～48(15±12)个月.药物溶栓组1例病情平稳,6例死于再发急性肠系膜动脉栓塞;支架置入组7例病情平稳,1例术后20个月死于急性心肌梗死(无肠缺血症状),1例术后28个月再发肠缺血,经肠系膜动脉置管溶栓后症状消失.结论支架置入在改善肠系膜上动脉闭塞引起肠缺血及提高患者生存率方面均显著优于药物保守治疗,为尚未出现肠坏死患者的治疗方案的选择提供了可靠依据.
목적 비교지가치입여약물용전치료급성장계막상동맥결혈적근、중기료효.방법 수집2004년1월지2008년12월,중국의과대학부속제일의원인장계막상동맥협착혹폐새인기급성장결혈주원환자35례.기중,지가치입12례(개입치료조),외주약물용전23례(약물용전조).개입치료조채용구낭확장급지가치입병보이항응、거취급확혈관치료,약물용전조채용뇨격매배합항응、거취급확혈관치료.량조환자출원후균구복록필격뢰급아사필림병진행수방.용Fisher학절개솔법비교분석량조료효차이적현저성.결과 약물용전조림상유효7례,무효16례(가중혹사망7례,치료실패행부분장절제9례).개입치료조10례치입지가(1례술후제3천사우급성심기경사),2례개통실패.수방1～48(15±12)개월.약물용전조1례병정평은,6례사우재발급성장계막동맥전새;지가치입조7례병정평은,1례술후20개월사우급성심기경사(무장결혈증상),1례술후28개월재발장결혈,경장계막동맥치관용전후증상소실.결론 지가치입재개선장계막상동맥폐새인기장결혈급제고환자생존솔방면균현저우우약물보수치료,위상미출현장배사환자적치료방안적선택제공료가고의거.
Objective To compare the short-term and medium-term result of stent implantation with pharmaceutical thrombolysis in patients with acute superior mesenteric artery occlusion. Methods From January, 2004 to December, 2008, thirty-five patients diagnosed acute superior mesenteric ischemia, 12 patients treated with stent implantation ( interventional therapy group) and 23 patients with pharmaceutical thrombolysis(thrombolytic therapy group). Interventional therapy group treated with balloon dilatation and stent implantation assisted with anticoagulation, antiplatelet and vascular dilation agents. Thrombolytic therapy group used urokinase combined with anticoagulation, antiplatelet and vascular dilation agents. All patients had tsken clopidogrel and aspirin orally after discharged and followed up. The clinical effects of both groups were evaluated separately and the Fisher exact test was used to analysis the significant differences. Results In the 23 cases of thrombolytic therapy group, 7 cases was effective, 16 cases was ineffective(7 cases aggravated or died, 9 cases turn to surgical operation). In the 12 cases of interventional therapy group, 10 cases treated with stent implantation( 1 case died of acute cardiac infarction 3 days after interventional operation), 2 cases failed in racanalizing. All patients were followed up after discharged (range 1 -48 months, mean 15 ± 12 months), 1 case in thrombolytic therapy group was stable, 6 cases died of the recurrence of acute superior mesenteric artery occlusion; 7 cases in interventional therapy group was stable, 1 case died of acute cardiac infarction 20 months after interventional operation ( intestinal ischemia not appeared ), 1 case had intestinal ischemia reoccurred and recovered by superior mesenteric artery thrombolysis. Conclusions In the treatment of acute superior mesenteric ischemia, stent implantation was obviously superior to pharmaceutical thrombolysis in improving intestinal ischemia and survival, therefore it could provided a reliable choice for the patients who had not appeared intestinal necrosis.