自发性孤立性腹腔干动脉夹层的形态学分型和治疗策略
发布时间：2018-08-24 15:18
【摘要】：目的评估自发性孤立性腹腔干动脉夹层(spontaneous isolated dissection of the celiac artery, SIDCA)的形态学调查结果和临床治疗经验,希望能够探索出该疾病的治疗策略。方法对自2009年1月至2014年12月的23个在我科就诊的自发性孤立性腹腔干夹层患者进行了回顾性研究,对这一系列患者的人口学数据、临床特征、形态学研究结果、治疗方法和随访结果进行了评估,并根据我们之前报道过的自发性孤立性肠系膜上动脉夹层的形态学分类,提出了一个关于自发性孤立性腹腔干动脉夹层的形态学分型。结果在这23例患者中,11位患者接受了血管腔内介入治疗,12位患者在最初使用了药物保守治疗。在保守治疗的患者中,4例患者因为夹层的进展而进行了腔内治疗的补救。所有接受腔内介入治疗的病人都在术后恢复顺利,没有发生腹痛、再次介入干预及死亡等情况。随访结果显示,在药物治疗组中,4位患者的夹层假腔完全形成血栓并吸收,2例部分形成血栓,还有2例患者的夹层假腔一直存在；在腔内治疗组中,所有患者均保持支架内血流通畅且假腔完全形成血栓吸收。结论自发性孤立性腹腔干动脉夹层是一种罕见的血管性疾病,对于病情稳定的患者可以进行药物的保守治疗,但需要进行严密的随访。对于反复有腹痛等临床症状、内脏器官血供灌注不良或形态学上有夹层动脉瘤形成的高危患者可以实施血管腔内介入治疗。当腔内治疗不合适或失败时可以考虑开放手术。血管腔内介入治疗的短期结果是令人鼓舞的,但是长期随访来进一步评估治疗的效果依然是必须的。
[Abstract]:Objective to evaluate the morphologic findings and clinical treatment experience of spontaneous solitary celiac artery dissection (spontaneous isolated dissection of the celiac artery, SIDCA) in order to explore the treatment strategy of the disease. Methods A retrospective study was conducted on 23 patients with spontaneous and isolated dissection of abdominal cavity from January 2009 to December 2014 in our department. The demographic data, clinical features and morphological findings of these patients were analyzed. The therapeutic methods and follow-up results were evaluated. According to the morphological classification of spontaneous isolated superior mesenteric artery dissection, a morphological classification of spontaneous solitary dissection of the celiac trunk artery was proposed. Results of the 23 patients, 11 received endovascular intervention and 12 received conservative drug therapy initially. Four of the conservative patients underwent endovascular treatment because of the progression of dissection. All patients who received endovascular intervention recovered smoothly without abdominal pain, re-intervention and death. The results of follow-up showed that in the drug treatment group, 4 patients had complete thrombus formation in the dissection and 2 patients had partial thrombus absorption, and 2 patients had always had the dissection false lumen, and in the intracavitary treatment group, In all patients, the blood flow in the stent was patency and thrombus absorption was completely formed in the pseudolumen. Conclusion spontaneous isolated dissection of celiac trunk artery is a rare vascular disease. Patients with stable condition can be treated with medicine conservatively, but should be followed up closely. For the patients with recurrent abdominal pain and other clinical symptoms, the high risk patients with poor blood perfusion of visceral organs or dissecting aneurysms in morphology can be treated with endovascular interventional therapy. Open surgery may be considered when endovascular treatment is inappropriate or fails. The short-term outcome of endovascular intervention is encouraging, but long-term follow-up to further evaluate the effectiveness of treatment is still necessary.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R654.3
[Abstract]:Objective to evaluate the morphologic findings and clinical treatment experience of spontaneous solitary celiac artery dissection (spontaneous isolated dissection of the celiac artery, SIDCA) in order to explore the treatment strategy of the disease. Methods A retrospective study was conducted on 23 patients with spontaneous and isolated dissection of abdominal cavity from January 2009 to December 2014 in our department. The demographic data, clinical features and morphological findings of these patients were analyzed. The therapeutic methods and follow-up results were evaluated. According to the morphological classification of spontaneous isolated superior mesenteric artery dissection, a morphological classification of spontaneous solitary dissection of the celiac trunk artery was proposed. Results of the 23 patients, 11 received endovascular intervention and 12 received conservative drug therapy initially. Four of the conservative patients underwent endovascular treatment because of the progression of dissection. All patients who received endovascular intervention recovered smoothly without abdominal pain, re-intervention and death. The results of follow-up showed that in the drug treatment group, 4 patients had complete thrombus formation in the dissection and 2 patients had partial thrombus absorption, and 2 patients had always had the dissection false lumen, and in the intracavitary treatment group, In all patients, the blood flow in the stent was patency and thrombus absorption was completely formed in the pseudolumen. Conclusion spontaneous isolated dissection of celiac trunk artery is a rare vascular disease. Patients with stable condition can be treated with medicine conservatively, but should be followed up closely. For the patients with recurrent abdominal pain and other clinical symptoms, the high risk patients with poor blood perfusion of visceral organs or dissecting aneurysms in morphology can be treated with endovascular interventional therapy. Open surgery may be considered when endovascular treatment is inappropriate or fails. The short-term outcome of endovascular intervention is encouraging, but long-term follow-up to further evaluate the effectiveness of treatment is still necessary.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R654.3
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