摘要
目的了解目前关于孤立性肠系膜上动脉夹层(isolated superior mesenteric artery dissection,ISMAD)腔内治疗的研究现状,为血管外科医生及患者选择治疗方式提供参考。方法收集近年来国内外关于ISMAD腔内治疗相关研究的文献并进行归纳总结。结果目前ISMAD腔内治疗方法主要有置管溶栓术和支架置入术。置管溶栓术对于真腔内血栓形成、真腔闭塞及分支血管部分栓塞的ISMAD患者,通过局部持续泵入尿激酶溶解血栓,以改善远端血供。支架置入术则包括裸支架置入术和覆膜支架置入术两大类,均旨在通过机械支撑和血流导向作用促进真腔再通、假腔血栓化及血管重塑。裸支架具有发展成熟、可选择范围广、性能稳定等独特优势。而覆膜支架则在维持中期通畅率和防止支架内再狭窄方面优于裸支架。结论随着技术的发展,血管腔内治疗已成为ISMAD患者重要的治疗手段。来自国内外的多中心的大量病例报道结果为腔内治疗的安全性和有效性提供了支撑。置管溶栓术和支架置入术(裸支架置入和覆膜支架置入)为不同类型的ISMAD患者提供了具有针对性的解决方案,可以为患者提供更微创和更有效的治疗选择。
Objective To explore the current research status of endovascular treatment for isolated superior mesenteric artery dissection(ISMAD)so as to provide a reference for vascular surgeons and patients in selecting treatment methods.Method The recent domestic and international literature on the endovascular treatment for ISMAD was collected and summarized.Results The current endovascular treatment methods for ISMAD mainly included catheterdirected thrombolysis and stent placement.For the ISMAD patients with true intraluminal thrombus formation,true luminal occlusion,and partial embolization of branch vessels,the catheter-directed thrombolysis was performed by continuously pumping urokinase locally to dissolve thrombus and improve distal blood supply.The stent placement mainly included two main types:bare stent placement and covered stent placement,both aiming to promote true lumen recanalization,false lumen thrombosis,and vascular remodeling through mechanical support and blood flow redirection.The bare stents had unique advantages such as being well-developed,offering a wide range of options,and having stable performance.However,covered stents were superior to bare stents in terms of mid-term patency rate and in-stent restenosis.Conclusions With the development of technology,endovascular treatment has become an indispensable method for ISMAD patients.Extensive multicenter cases reports from both domestic and international studies have supported the safety and efficacy of endovascular treatment.Catheter-directed thrombolysis and stent placement(bare stent and covered stent)offer targeted solutions for various types of ISMAD patients,providing more minimally invasive and effective treatment.
作者
满家豪
唐博
MAN Jiahao;TANG Bo(Department of Vascular Surgery,The Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,P.R.China;Department of General Surgery,University-Town Hospital of Chongqing Medical University,Chongqing 401331,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2024年第9期1147-1152,共6页
Chinese Journal of Bases and Clinics In General Surgery
关键词
肠系膜上动脉
动脉瘤
夹层
支架
治疗
综述
superior mesenteric artery
aneurysm
dissection
stent
treatment
review
