症状性内脏动脉夹层影像学诊断和介入治疗

摘要

Objective To summarize the experience in the diagnosis and treatment of symptomatic splanchnic artery dissection. Methods A total of 21 patients with symptomatic splanchnic artery dissection, who were admitted to the Affiliated First Hospital of China Medical University during the period from June 2006 to March 2014, were included in this study. Combined with the literature, the clinical data, including the diagnosis and treatment, were analyzed. Results Contrast-enhanced abdominal CT and CT angiography revealed superior mesenteric artery dissection in 15 cases, celiac artery dissection in 5 cases and splenic artery dissection in one case. Conservative therapy was employed in 5 patients; among them one was complicated with hepatic artery thrombosis. Of the 16 patients who received endovascular stent placement, additional intestinal resection was performed in 2 and transcatheter thrombolysis treatment in other 2. No procedure-related severe complications occurred in perioperative period. All the patients were followed up for 2-74 months (mean of 19.1 months). In patients who received endovascular stent placement, the abdominal pain and the bloody stool were relieved or disappeared, and no abdominal pain recurred. CT angiography showed that in-stent blood flow was fluent, the stent was in good position, and neither stenosis nor thrombosis was observed. One patient with superior mesenteric artery dissection died of stroke three months after the treatment. Conclusion It is very important to make early diagnosis and to adopt early treatment for symptomatic splanchnic artery dissection. CT angiography can confirm the diagnosis in most cases, but attention should be paid to some atypical manifestations. For the treatment of splanchnic artery dissection, endovascular stent placement is mini-invasive, safe and reliable.%目的：总结症状性内脏动脉夹层(SAD)影像学诊断和介入治疗经验。方法回顾中国医科大学附属第一医院2006年6月至2014年3月收治的21例症状性SAD患者的诊断和治疗方法,并结合相关文献进行分析。结果腹部增强CT和CTA检查显示15例为肠系膜上动脉夹层,5例腹腔干动脉夹层,1例脾动脉夹层。5例保守治疗患者中1例并发肝动脉血栓形成。16例血管腔内支架植入术(ESP)治疗患者中2例行ESP联合肠切除术,2例行置管溶栓联合ESP治疗；围手术期均未发生严重并发症。全部患者随访2~74个月,平均19.1个月。 ESP治疗患者腹部疼痛及血便症状明显缓解或消失,无腹痛复发；CTA显示支架内血流通畅,位置良好,无管腔狭窄及血栓形成。1例肠系膜上动脉夹层患者术后3个月因脑卒中死亡。结论症状性SAD应早期诊断、早期治疗。CTA检查能确诊大多数病变,但要注意不典型表现；ESP术是一种微创、安全有效的治疗方法。