本文選題：腸系膜上動脈 + 動脈夾層　； 參考：《山東醫(yī)藥》2017年25期

【摘要】：目的探討自發(fā)性孤立性腸系膜上動脈夾層(SISMAD)的病例特點及診治方案。方法回顧性分析濱州醫(yī)學(xué)院附屬醫(yī)院介入血管外科診治共11例SISMAD病例,分析其臨床特點、診治方案。結(jié)果 11例患者均為男性,年齡45~58歲,平均50歲。患者均經(jīng)CT血管造影(CTA)確診。11例患者中表現(xiàn)為腹痛8例,無癥狀體檢發(fā)現(xiàn)1例,腰背部疼痛1例,伴有惡心、嘔吐3例。有高血壓病史4例,有吸煙史4例。根據(jù)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破口距腸系膜上動脈起始部平均距離為33 mm,夾層的平均長度為57.72 mm。7例保守治療3~9 d后腹痛癥狀逐漸緩解、消失;1例行彈簧圈栓塞術(shù);1例保守治療失敗后采取腔內(nèi)支架治療,經(jīng)股動脈置入自膨式裸支架;1例保守治療5 d后腹痛癥狀未明顯緩解,行置管溶栓+罌粟堿灌注術(shù);1例Ⅲ型患者入院后腹痛癥狀加重,腹膜刺激征陽性,急癥行剖腹探查術(shù),行腸系膜上動脈取栓+小腸切除術(shù)。所有患者隨訪中除行腸系膜上動脈取栓+小腸切除術(shù)患者出現(xiàn)短腸綜合征外,其余腹痛癥狀消失。結(jié)論SISMAD臨床表現(xiàn)多樣,腹痛多見,亦可見惡心、嘔吐,腹瀉,腹脹,腰背部疼痛,便血,厭食,體質(zhì)量減輕等。多發(fā)于中年,男性居多。DSA是診斷SISMAD的金標(biāo)準(zhǔn)。保守治療對多數(shù)SISMAD有效,若腹痛癥狀未緩解或加重,應(yīng)改行腔內(nèi)治療或外科手術(shù)治療。
[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，

本文編號：1853986