孤立性肠系膜上动脉夹层的治疗选择：单中心经验

doi:10.3969/j.issn.1009-976X.2020.06.012

岭南现代临床外科 ›› 2020, Vol. 20 ›› Issue (06): 741-745.DOI: 10.3969/j.issn.1009-976X.2020.06.012

孤立性肠系膜上动脉夹层的治疗选择：单中心经验

李勇辉¹, 彭新治², 陈志波¹, 沈润楠³, 黄楷^1,*

中山大学孙逸仙纪念医院1.心血管外科; 2.甲状腺外科,广州市510120; 3.中山大学中山医学院,广州市510080

通讯作者: *黄楷,Email: maoqu183@163.com

Treatment of isolated superior mesenteric artery dissection： single-center experience

LI Yong-hui¹, PENG Xin-zhi², CHEN Zhi-bo¹, SHEN Run-nan³, HUANG Kai¹

1. Division of Cardiovascular Surgery, 2. Division of Thyroid Surgery,the Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510080, China, 3. Zhongshan School of Medicine of Sun Yat-sen University, Guangzhou 510080, China

Received:2020-08-24 Online:2020-12-20 Published:2020-12-20
Contact: HUANG Kai,maoqu183@163.com

摘要/Abstract

摘要： 目的孤立性肠系膜上动脉夹层（ISMAD）是相对罕见的一类疾病,其最佳治疗方式仍然未能确定,本研究拟总结本中心治疗ISMAD的临床结果和经验。方法回顾性收集和分析2014年4月至2020年6月期间在我院诊断为ISMAD患者的临床资料和随访资料。结果共有29名患者纳入本研究,其中28名患者为男性,1名患者为女性。有腹痛症状症16例。平均年龄为56.9±10.2岁。按照Yun分型,本研究包含12例Ⅰ型病变,8例Ⅱa型,8例Ⅱb型和1例Ⅲ型病变。共有13例接受观察治疗,5例行保守治疗,11例行腔内治疗。其中,1例接受腔内治疗者仍表现为腹膜炎,遂行开放手术。对于I型病变,均采取了观察治疗;对于Ⅱ型病变,采用保守治疗或者腔内治疗,对于Ⅲ型病变,采用腔内治疗基础上行坏死肠管切除。术后无腔内相关并发症。中位随访时间12（1~48）月,4例接受观察治疗的患者失访。接受肠切除的病例,有反复的出血的表现,遂停用抗凝,其随访4年的计算机断层扫描血管造影（CTA）结果显示,植入的支架通畅在位。余植入的支架通畅。未植入支架的病例,未见病变进展。结论观察治疗适用于无症状的ISMAD患者,保守治疗和腔内治疗适用于有症状ISMAD患者,开放手术适用于有肠坏死的患者。Yun分型可用于指导治疗方式的选择。

关键词: 孤立性肠系膜上动脉夹层, 单中心经验, Yun分型, 腔内治疗, 保守治疗

Abstract: Objective Isolated superior mesenteric artery dissection （sISMAD） is rare and its optimal treatment remains uncertain. The present study was performed to present our single-center clinical outcomes and experiences. Methods Patients who were diagnosed during the period from April 2014 to June 2020 were included. Clinical and follow-up data were retrospectively collected and analyzed. Results A total of 29 patients were involved. Twenty-eight male and 1 female were included, with a median age of 56.9± 10.2 years. According to Yun Classification, 12 cases, 8, 8 and 1 were classified as Type I,ⅡA, ⅡB and Ⅲ, respectively. Fourteen patients, 5 and 11 patients accepted observation treatment, conservative treatment and endovascular treatment, respectively. Among these, one case manifested with peritonitis, and he accepted further intestinal resection and anastomosis. All Type I patient underwent observation treatment, while Type Ⅱ underwent conservative treatment or endovascular treatment. The patient underwent endovascular treatment and sequent intestinal resection was classified as Type Ⅲ. During a median follow-up period of 12 months, four patients were lost to follow-up. The patient experienced intestinal resection developed repeated gastrointestinal bleeding, and antiplatelet treatment was discontinued. A computed tomography angiography（CTA） performed 4 years after endovascular treatment revealed that the stent was patent. Other stents was patent as well, confirmed by CTA. For those patients without stent implantation, no progression was observed. Conclusions Observation could be given for asymptomatic ISMAD patients, while conservative treatment and endovascular treatment are suitable for symptomatic ISMAD patients. As to patients with intestinal necrosis, open surgery should be considered. Yun Classification could be used for treatment option.

Key words: systematic isolated superior mesenteric artery dissection, conservative treatment, Yun Classification, endovascular treatment, single-center experience

中图分类号:

李勇辉, 彭新治, 陈志波, 沈润楠, 黄楷. 孤立性肠系膜上动脉夹层的治疗选择：单中心经验[J]. 岭南现代临床外科, 2020, 20(06): 741-745.

LI Yong-hui, PENG Xin-zhi, CHEN Zhi-bo, SHEN Run-nan, HUANG Kai. Treatment of isolated superior mesenteric artery dissection： single-center experience[J]. Lingnan Modern Clinics in Surgery, 2020, 20(06): 741-745.

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孤立性肠系膜上动脉夹层的治疗选择：单中心经验

Treatment of isolated superior mesenteric artery dissection： single-center experience

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