CAJ | 학술논문

目的探讨孤立性肠系膜上动脉夹层(isolated dissection of the superior mesenteric artery,IDSMA)的临床特点及治疗策略. 方法回顾性分析2008年9月至2012年10月北京大学第三医院介入血管外科收治的19例IDSMA患者的临床表现、诊断方法、治疗策略及效果等临床资料.其中男15例,女4例,年龄41 ～ 84岁,平均(56±12)岁.临床症状腹痛15例、无症状4例.18例经增强CT确诊、1例经超声诊断.结果 19例夹层均累及肠系膜上动脉弯曲部前壁.对于4例无症状患者,保守治疗3例,另1例假腔形成瘤样扩张,行支架植入.对有症状的15例患者采取腔内治疗,包括经留置导管动脉内区域性解痉治疗4例；支架植入11例.全部患者均治愈,无并发症.随访时间7～46个月,平均(21±10)个月,19例均无症状,彩超和增强CT显示支架均通畅.结论 IDSMA均发生于肠系膜上动脉弯曲部的前壁.对无症状患者可行保守治疗.对有症状患者,如无动脉破裂或肠坏死,推荐植入支架、完全覆盖肠系膜上动脉弯曲部.经导管动脉内区域性解痉治疗是有效的辅助治疗措施.
목적 탐토고립성장계막상동맥협층(isolated dissection of the superior mesenteric artery,IDSMA)적림상특점급치료책략. 방법 회고성분석2008년9월지2012년10월북경대학제삼의원개입혈관외과수치적19례IDSMA환자적림상표현、진단방법、치료책략급효과등림상자료.기중남15례,녀4례,년령41 ～ 84세,평균(56±12)세.림상증상복통15례、무증상4례.18례경증강CT학진、1례경초성진단.결과 19례협층균루급장계막상동맥만곡부전벽.대우4례무증상환자,보수치료3례,령1례가강형성류양확장,행지가식입.대유증상적15례환자채취강내치료,포괄경류치도관동맥내구역성해경치료4례；지가식입11례.전부환자균치유,무병발증.수방시간7～46개월,평균(21±10)개월,19례균무증상,채초화증강CT현시지가균통창.결론 IDSMA균발생우장계막상동맥만곡부적전벽.대무증상환자가행보수치료.대유증상환자,여무동맥파렬혹장배사,추천식입지가、완전복개장계막상동맥만곡부.경도관동맥내구역성해경치료시유효적보조치료조시.
Objective To study the clinical characteristics and treatment strategy for isolated dissection of the superior mesenteric artery (SMA).Methods Clinical data of 19 consecutive patients with IDSMA were retrospectively analyzed.There were 15 men and 4 women.The mean age was 56 ± 12 (41-84) years old.Fifteen patients presented with abdominal pain and 4 patients had no symptom.The dissections were diagnosed by contrast-enhanced computed tomography in 18 patients and ultrasonography in 1 patient.Results The dissections were located at the anterior wall of the curvature part of the SMA in all 19 patients.Asymptomatic patients underwent conservative management.One asymptomatic patient with aneurysmal dilation was managed by stent and the 15 symptomatic patients underwent endovascular management.During the mean 7-46 (21 ± 10) months follow-up period,all patients were asymptomatic with patency of SMA.Conclusions The dissection was located at the anterior wall of the curvature part of the SMA.Conservative management can be applied to the asymptomatic patients.For symptomatic patients without intestinal necrosis or artery rupture,stent implantation is recommended,and the curvature of SMA should be covered completely.Endovascular spasmolysis is helpful in relieving pain.