CAJ | 학술논문

目的探讨肠系膜上动脉(SMA)狭窄/闭塞所致缺血性肠病的诊断和治疗策略.方法 20例SMA狭窄/闭塞患者,男14例,女6例;年龄40～ 75岁,平均67.5岁.病程1～ 62个月,平均15.5个月.5例SMA闭塞患者采用外科治疗,15例患者(11例狭窄、4例闭塞)行SMA球囊扩张+支架置入术.术后常规使用抗凝药物.17例随访1～32个月,平均11.5个月.结果全组术后1周内症状消失,疗效满意.随访期间,1例行支架置入患者术后32个月死于突发心肌梗死.支架闭塞和支架内约50％的狭窄各1例,但症状轻微,根据患者的意愿未处理;支架轻度狭窄(约30％)3例,患者无任何腹部不适,暂未处理;1例转流患者术后18个月时突发持续性腹痛,手术探查,经人工血管取栓后造影发现人工血管与SMA吻合口狭窄,再行PTA+球囊扩张支架置入术,正在随访中.其余患者随访期间未发现SMA再狭窄/闭塞征象.结论腔内治疗可作为SMA狭窄/闭塞致肠缺血的首选治疗方法.对于复杂病例采用杂交手术治疗,可以减少并发症的发生.
목적 탐토장계막상동맥(SMA)협착/폐새소치결혈성장병적진단화치료책략.방법 20례SMA협착/폐새환자,남14례,녀6례;년령40～ 75세,평균67.5세.병정1～ 62개월,평균15.5개월.5례SMA폐새환자채용외과치료,15례환자(11례협착、4례폐새)행SMA구낭확장+지가치입술.술후상규사용항응약물.17례수방1～32개월,평균11.5개월.결과 전조술후1주내증상소실,료효만의.수방기간,1례행지가치입환자술후32개월사우돌발심기경사.지가폐새화지가내약50％적협착각1례,단증상경미,근거환자적의원미처리;지가경도협착(약30％)3례,환자무임하복부불괄,잠미처리;1례전류환자술후18개월시돌발지속성복통,수술탐사,경인공혈관취전후조영발현인공혈관여SMA문합구협착,재행PTA+구낭확장지가치입술,정재수방중.기여환자수방기간미발현SMA재협착/폐새정상.결론 강내치료가작위SMA협착/폐새치장결혈적수선치료방법.대우복잡병례채용잡교수술치료,가이감소병발증적발생.
Objective To discuss the diagnosis and treatment options for ischemic enteropathy due to superior mesenteric artery (SMA) stenosis/occlusion.Methods Five cases with SMA occlusion were treated surgically and 15 cases underwent balloon angioplasty and stent implantation.Post-procedure anticoagulative and antiplatelet therapy were employed routinely.17 cases were followed up for 3 to 32 months.Results All patients achieved satisfactory results with disappearance of symptoms within one week postoperatively.One patient with stent placement died suddenly 32 months postoperatively due to acute myocardial infarction although he was free of abdominal symptoms during follow-up period.Stent occlusion and in-stent stenosis of about 50％ were found in 1 case each,and mild in-stent stenosis (approximately 30％) were present in 3 cases.No further intervention were adopted for the above-mentioned patients; Sudden persistent abdominal pain occurred at 18th month postoperatively in one patient who had received SMA embolectomy and infrarenal aorto-SMA bypass due to SMA total occlusion.Graft-to-SMA anastomotic stenosis was revealed during intraoperative angiography following graft-and SMA embolectomy,and one balloon expandable stent was deployed at the anastomosis.He recovered uneventfully and is currently being observed.No signs of SMA stenosis / occlusion were found in the remaining patients during follow-up period.Conclusion Duplux,CTA and angiography are of great significance to the diagnosis of SMA stenosis / occlusion.Endovascular treatment is the procedure of choice for this entity.In complicated cases with high surgical risk,the ingenious combination of different treatment modalities (hybrid technique) can simplify treatment and reduce the incidence of complications.