摘要
目的探讨不同方法治疗自发孤立性肠系膜上动脉夹层(SIDSMA)的安全性及有效性。方法回顾性分析自2015年3月至2017年12月北部战区总医院心血管外科收治并经CT血管造影(CTA)或数字减影血管造影(DSA)明确诊断的20例SIDSMA患者的临床资料。根据治疗措施将患者分为保守治疗组、腔内治疗组及复合或开放手术组。术后随访,记录保守治疗组与腔内治疗组患者的腹痛及消化道症状好转情况、术前真腔狭窄程度、平均住院时间、多层CT血管造影检查结果及并发症情况。结果最终纳入保守治疗组8例,腔内治疗组10例,复合或开放手术组2例。所有患者出院后均获得随访,随访期间,保守治疗组1例在出院后1个月再次出现腹痛、腹泻症状,考虑可能与保守治疗本身无法改善夹层进展及患者饮食不良习惯而加重肠道负担有关;腔内治疗组1例术后支架远端出现附壁血栓。保守治疗组术前真腔狭窄程度小于腔内治疗组,腔内治疗组平均住院时间少于保守治疗组,差异有统计学意义(P<0.05);腔内治疗组腹痛或消化道症状改善率、复查CTA影像学改善率优于保守治疗组,但组间比较,差异无统计学意义(P>0.05)。结论肠系膜上动脉夹层病情复杂多变,应根据不同治疗方法的优缺点进行个性化治疗。
Objective To investigate the safety and efficacy of different treatments for spontaneous isolated dissection of superior mesenteric artery(SIDSMA).Methods A retrospective study was performed on 20 cases of SIDSMA patients who were admitted and underwent CT angiography(CTA)or digital subtraction angiography(DSA)from March 2015 to December 2017.Patients were divided into the conservative treatment group,intracavitary treatment group and compound or open surgery group according to treatment measures.Postoperative follow-up was conducted to record the improvement of abdominal pain and gastrointestinal symptoms,preoperative true lumen stenosis,average length of stay,results of multi-slice CT angiography and complications of patients in the conservative treatment group and the intracavitary treatment group.Results Finally,8 cases were included in the conservative treatment group,10 cases were included in the intracavitary treatment group,and 2 cases were included in the compound or open surgery group.All patients were followed up after discharge.During the follow-up period,1 patient in the conservative treatment group presented abdominal pain and diarrhea symptoms again 1 month after discharge,which might be related to the failure of the conservative treatment to improve the progress of interlayer and the aggravation of intestinal burden due to the patients'poor eating habits.Mural thrombosis was observed at the distal end of the stent in 1 patient in the intracavitary treatment group.The degree of preoperative true cavity stenosis in the conservative treatment group was lower than that in the intracavitary treatment group,and the average hospital stay in the intracavitary treatment group was shorter than that in the conservative treatment group,with statistically significant difference(P<0.05).The improvement rate of abdominal pain or gastrointestinal symptoms and CTA imaging in the intracavitary treatment group was better than that in the conservative treatment group,but the difference between the two groups was not statistically significant(P>0.05).Conclusion The condition of spontaneous isolated dissection of superior mesenteric artery is complex and changeable,so individualized treatment should be carried out according to the advantages and disadvantages of different treatment methods.
作者
陈燕
李俊
CHEN Yan;LI Jun(Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang 110016,China)
出处
《临床军医杂志》
CAS
2020年第6期645-648,共4页
Clinical Journal of Medical Officers
基金
辽宁省自然科学基金(2020-BS-032)。
关键词
肠系膜上动脉
夹层
抗凝
支架
复合手术
Superior mesenteric artery
Dissection
Anticoagulation
Stent
Hybird surgery
