CAJ | 학술논문

目的探讨对急性肠系膜上动脉缺血行腔内介入治疗的有效性和安全性.方法回顾性分析201 1年7月至2014年12月重庆医科大学附属第一医院收治的55例急性肠系膜上动脉缺血患者的临床资料.患者术前DSA与CT检查结果一致:肠系膜上动脉主干栓塞34例,肠系膜上动脉分支栓塞17例,肠系膜上动脉夹层并发急性血栓形成4例.患者均首先采用腔内介入治疗;若腹部症状、体征,血常规及影像学检查结果提示肠坏死,则立即行剖腹探查;若术中证实为肠坏死,则行肠切除+肠吻合术.采用门诊方式进行随访,随访时间截至2015年3月.分析患者腔内介入治疗结果、腔内介入治疗的后续治疗情况、术后并发症、30 d病死率、随访期间复发率和病死率.结果 55例患者从出现腹部疼痛到行腔内介入治疗的平均间隔时间为10.1 h(4.0～15.0 h),动脉完全再通率为32.7％ (18/55),其中8例肠系膜上动脉主干栓塞,9例肠系膜上动脉分支栓塞,1例肠系膜上动脉主干夹层;部分再通率为63.6％(35/55),其中26例肠系膜上动脉主干栓塞,8例肠系膜上动脉分支栓塞,1例肠系膜上动脉主干夹层;2例肠系膜上动脉夹层患者腔内治疗无效,后行支架置入痊愈.9例肠系膜上动脉主干栓塞患者在腔内介入治疗后11～24 h内行剖腹探查+肠切除+肠吻合术,切除小肠平均长度为103 cm(74～201 cm).患者住院期间均未发生大出血,2例患者出现穿刺点渗血,经压迫止血等处理后好转.55例患者均获得随访,中位随访时间为5个月(2 ～14个月).术后1个月内,5例患者死亡,患者30 d病死率为9.1％ (5/55);其余患者无腹痛复发.术后5个月,3例患者出现腹痛症状,之后证实非肠系膜动脉缺血所致.2例行支架置入术患者随访9个月未出现复发.其余患者随访期间未出现肠系膜上动脉缺血复发.结论对急性肠系膜上动脉缺血行腔内介入治疗能尽快恢复肠道血供,降低患者病死率,是一种安全、有效的治疗手段. 目的探討對急性腸繫膜上動脈缺血行腔內介入治療的有效性和安全性.方法迴顧性分析201 1年7月至2014年12月重慶醫科大學附屬第一醫院收治的55例急性腸繫膜上動脈缺血患者的臨床資料.患者術前DSA與CT檢查結果一緻:腸繫膜上動脈主榦栓塞34例,腸繫膜上動脈分支栓塞17例,腸繫膜上動脈夾層併髮急性血栓形成4例.患者均首先採用腔內介入治療;若腹部癥狀、體徵,血常規及影像學檢查結果提示腸壞死,則立即行剖腹探查;若術中證實為腸壞死,則行腸切除+腸吻閤術.採用門診方式進行隨訪,隨訪時間截至2015年3月.分析患者腔內介入治療結果、腔內介入治療的後續治療情況、術後併髮癥、30 d病死率、隨訪期間複髮率和病死率.結果 55例患者從齣現腹部疼痛到行腔內介入治療的平均間隔時間為10.1 h(4.0～15.0 h),動脈完全再通率為32.7％ (18/55),其中8例腸繫膜上動脈主榦栓塞,9例腸繫膜上動脈分支栓塞,1例腸繫膜上動脈主榦夾層;部分再通率為63.6％(35/55),其中26例腸繫膜上動脈主榦栓塞,8例腸繫膜上動脈分支栓塞,1例腸繫膜上動脈主榦夾層;2例腸繫膜上動脈夾層患者腔內治療無效,後行支架置入痊愈.9例腸繫膜上動脈主榦栓塞患者在腔內介入治療後11～24 h內行剖腹探查+腸切除+腸吻閤術,切除小腸平均長度為103 cm(74～201 cm).患者住院期間均未髮生大齣血,2例患者齣現穿刺點滲血,經壓迫止血等處理後好轉.55例患者均穫得隨訪,中位隨訪時間為5箇月(2 ～14箇月).術後1箇月內,5例患者死亡,患者30 d病死率為9.1％ (5/55);其餘患者無腹痛複髮.術後5箇月,3例患者齣現腹痛癥狀,之後證實非腸繫膜動脈缺血所緻.2例行支架置入術患者隨訪9箇月未齣現複髮.其餘患者隨訪期間未齣現腸繫膜上動脈缺血複髮.結論對急性腸繫膜上動脈缺血行腔內介入治療能儘快恢複腸道血供,降低患者病死率,是一種安全、有效的治療手段.
목적 탐토대급성장계막상동맥결혈행강내개입치료적유효성화안전성.방법 회고성분석201 1년7월지2014년12월중경의과대학부속제일의원수치적55례급성장계막상동맥결혈환자적림상자료.환자술전DSA여CT검사결과일치:장계막상동맥주간전새34례,장계막상동맥분지전새17례,장계막상동맥협층병발급성혈전형성4례.환자균수선채용강내개입치료;약복부증상、체정,혈상규급영상학검사결과제시장배사,칙립즉행부복탐사;약술중증실위장배사,칙행장절제+장문합술.채용문진방식진행수방,수방시간절지2015년3월.분석환자강내개입치료결과、강내개입치료적후속치료정황、술후병발증、30 d병사솔、수방기간복발솔화병사솔.결과 55례환자종출현복부동통도행강내개입치료적평균간격시간위10.1 h(4.0～15.0 h),동맥완전재통솔위32.7％ (18/55),기중8례장계막상동맥주간전새,9례장계막상동맥분지전새,1례장계막상동맥주간협층;부분재통솔위63.6％(35/55),기중26례장계막상동맥주간전새,8례장계막상동맥분지전새,1례장계막상동맥주간협층;2례장계막상동맥협층환자강내치료무효,후행지가치입전유.9례장계막상동맥주간전새환자재강내개입치료후11～24 h내행부복탐사+장절제+장문합술,절제소장평균장도위103 cm(74～201 cm).환자주원기간균미발생대출혈,2례환자출현천자점삼혈,경압박지혈등처리후호전.55례환자균획득수방,중위수방시간위5개월(2 ～14개월).술후1개월내,5례환자사망,환자30 d병사솔위9.1％ (5/55);기여환자무복통복발.술후5개월,3례환자출현복통증상,지후증실비장계막동맥결혈소치.2례행지가치입술환자수방9개월미출현복발.기여환자수방기간미출현장계막상동맥결혈복발.결론 대급성장계막상동맥결혈행강내개입치료능진쾌회복장도혈공,강저환자병사솔,시일충안전、유효적치료수단.
Objective To investigate the feasibility and safety of endovascular interventional treatment for acute superior mesenteric artery ischemia.Methods The clinical data of 55 patients with acute superior mesenteric artery ischemia who were admitted to the First Affiliated Hospital of Chongqing Medical University from July 2011 to December 2014 were retrospectively analyzed.The result of preoperative digital subtraction angiography (DSA) was in accord with computed tomography (CT),showing that 34 patients had superior mesenteric artery trunk embolism,17 patients had superior mesenteric artery branch embolism,and 4 patients had artery dissection complicated with acute thrombosis.All patients firstly received endovascular interventional treatment.Abdominal exploration would be done if abdominal symptoms,signs,blood routine and imaging examinations indicated intestinal necrosis.Enterotomy and enteroanastomosis were done when intestinal necrosis was confirmed during the operation.Patients were followed up by outpatient examination till March 2015.The outcomes of endovascular interventional treatment,sequential treatment after endovascular interventional treatment,postoperative complications,30-day mortality,recurrence rate and mortality during the follow-up were analyzed.Results The median duration from onset of symptoms to endovascular intervention was 10.1 hours (range,4.0-15.0 hours).Complete recanalization rate was 32.7％ (18/55),including 8 cases of superior mesenteric artery trunk embolism,9 cases of superior mesenteric artery branch embolism and 1 case of superior mesenteric artery dissection.Partial technical recanalization rate was 63.6％ (35/55),including 26 cases of superior mesenteric artery trunk embolism,8 cases of superior mesenteric artery branch embolism and 1 case of superior mesenteric artery dissection.Two patients who did not respond to endovascular interventional treatment recovered after stent implantation.Nine patients with superior mesenteric artery trunk embolism underwent laparotomy + enterectomy + enteroanastomosis within 11-24 hours after thrombolysis.The mean length of resected small intestine was 103 cm (range,74-201 cm).During hospitalisation,2 patients suffered from puncture site bleeding and recovered after compression hemostasis and no patient suffered from massive hemorrhage.All the 55 patients were followed up for a median time of 5 months (range,2-14 months).Five patients died with 30-day mortality of 9.1％ (5/55) with in postoperative 30 days.Abdominal pain did not recur in other patients.During postoperative month 5,3 patients suffered from abdominal pain and were confirmed not caused by superior mesenteric artery ischemia.Two patients with stent implantation had no recurrence during the follow-up 9 months.The rest patients showed no recurrence of superior mesenteric artery ischemia.Conclusion Endovascular interventional treatment can restore the intestinal blood supply quickly and reduce mortality,and is safe and feasible treatment method for superior mesenteric artery ischemia.