自发性孤立性肠系膜上动脉夹层11例临床分析

发布时间：2018-05-06 21:35

  本文选题：肠系膜上动脉 + 动脉夹层　； 参考：《山东医药》2017年25期

【摘要】：目的探讨自发性孤立性肠系膜上动脉夹层(SISMAD)的病例特点及诊治方案。方法回顾性分析滨州医学院附属医院介入血管外科诊治共11例SISMAD病例,分析其临床特点、诊治方案。结果 11例患者均为男性,年龄45~58岁,平均50岁。患者均经CT血管造影(CTA)确诊。11例患者中表现为腹痛8例,无症状体检发现1例,腰背部疼痛1例,伴有恶心、呕吐3例。有高血压病史4例,有吸烟史4例。根据SISMAD的Yun分型,其中Ⅰ型3例,Ⅱa型3例,Ⅱb型3例,Ⅲ型2例。第1破口距肠系膜上动脉起始部平均距离为33 mm,夹层的平均长度为57.72 mm。7例保守治疗3~9 d后腹痛症状逐渐缓解、消失;1例行弹簧圈栓塞术;1例保守治疗失败后采取腔内支架治疗,经股动脉置入自膨式裸支架;1例保守治疗5 d后腹痛症状未明显缓解,行置管溶栓+罂粟碱灌注术;1例Ⅲ型患者入院后腹痛症状加重,腹膜刺激征阳性,急症行剖腹探查术,行肠系膜上动脉取栓+小肠切除术。所有患者随访中除行肠系膜上动脉取栓+小肠切除术患者出现短肠综合征外,其余腹痛症状消失。结论SISMAD临床表现多样,腹痛多见,亦可见恶心、呕吐,腹泻,腹胀,腰背部疼痛,便血,厌食,体质量减轻等。多发于中年,男性居多。DSA是诊断SISMAD的金标准。保守治疗对多数SISMAD有效,若腹痛症状未缓解或加重,应改行腔内治疗或外科手术治疗。
[Abstract]:Objective to investigate the characteristics, diagnosis and treatment of spontaneous isolated superior mesenteric artery dissection (SISMAD). Methods 11 cases of SISMAD were retrospectively analyzed in the interventional vascular surgery of affiliated Hospital of Binzhou Medical College. Results all the 11 patients were male, aged 45 to 58 years (mean 50 years). All the patients were diagnosed as abdominal pain by CT angiography (CTAA) in 8 cases, asymptomatic physical examination in 1 case, back pain in 1 case, nausea and vomiting in 3 cases. There were 4 cases of hypertension and 4 cases of smoking. According to the Yun classification of SISMAD, there were 3 cases of type 鈪，

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