自发孤立性肠系膜上动脉夹层五例诊治分析
摘要
目的总结自发孤立性肠系膜上动脉夹层(SIDSMA)的诊治体会。方法自发孤立性肠系膜上动脉夹层5例,收集其一般资料、诊断手段及治疗结果等数据,探讨SIDSMA的误诊原因、确诊手段及治疗方案。结果 5例病人均为男性,平均年龄55.0,以腹痛为主要表现,平均就诊时间为56.2小时,就诊初步诊断为胃炎、尿路结石、胃溃疡各1例,确诊为SIDSMA 2例,平均确诊时间3天,5例病人初诊时行彩超均未发现病变,均以CTA检查确诊。5例病人均首先采用保守治疗,2例因保守治疗腹痛缓解不明显行介入支架手术,1例因长时间(3个月)饭后腹痛行介入支架植入。结论自发孤立性肠系膜上动脉夹层的误诊率较高;SIDSMA需以CTA确诊,彩超可作为随访手段;保守治疗对于SIDSMA疗效较好,即使对于部分肠系膜上动脉真腔严重狭窄的病人,可作为首选方案。介入手术或开放手术可作为腹痛缓解不明显、动脉瘤样变明显及肠坏死病人的进一步治疗手段。
引文
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[4] Jing Yuan Luan,Xin Guan,Xuan Li,et al.Isolated superior mesenteric artery dissection in China[J].J Vasc Surg,2016,63(2):530-536.
[5] 吴小洁,王诗斌.孤立性肠系膜上动脉夹层动脉瘤应用超声诊断的价值[J].中国医学装备,2017,14(11):72-74.
[6] Heo SH,Kim YW,Woo SY et al.Treatment strategy based on the natural course for patients with spontaneous isolated superiormesenteric artery dissection[J].J Vasc Surg,2017,65(4):1142-1151.
[7] 毕乐昌,黄飞来,王国富,等.介入治疗 63 例自发性孤立性肠系膜上动脉夹层病人临床效果及应用CT诊断的意义[J].浙江创伤外科,2017,22(2):298-299.
[8] Min SI,Yoon KC,Min SK,et al.Current strategy for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery[J].J Vasc Surg,2011,54:461-466.
[9] 刘建勇,张维康.急性肠系膜缺血102例诊治分析[J].临床外科杂志,2017,25(9):665-667.
[2] Sakamoto I,Ogawa Y,Sueyoshi E,et al.Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery[J].Eur J Radiol,2007,64:103-110.
[3] Bauersfeld SR.Dissecting aneurysm of the aorta:a presentation of fifteen cases and a review of the recent literature[J].Ann Intern Med,1947,26:873-879.
[4] Jing Yuan Luan,Xin Guan,Xuan Li,et al.Isolated superior mesenteric artery dissection in China[J].J Vasc Surg,2016,63(2):530-536.
[5] 吴小洁,王诗斌.孤立性肠系膜上动脉夹层动脉瘤应用超声诊断的价值[J].中国医学装备,2017,14(11):72-74.
[6] Heo SH,Kim YW,Woo SY et al.Treatment strategy based on the natural course for patients with spontaneous isolated superiormesenteric artery dissection[J].J Vasc Surg,2017,65(4):1142-1151.
[7] 毕乐昌,黄飞来,王国富,等.介入治疗 63 例自发性孤立性肠系膜上动脉夹层病人临床效果及应用CT诊断的意义[J].浙江创伤外科,2017,22(2):298-299.
[8] Min SI,Yoon KC,Min SK,et al.Current strategy for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery[J].J Vasc Surg,2011,54:461-466.
[9] 刘建勇,张维康.急性肠系膜缺血102例诊治分析[J].临床外科杂志,2017,25(9):665-667.