慢性肠系膜上动脉(SMA)狭窄%2f闭塞的外科及腔内治疗.pdfVIP

慢性肠系膜上动脉(SMA)狭窄/闭塞的外科及腔内治疗 首都医科大学附属北京朝阳医院血管外科 100020 杨宝钟，宋盛晗，邢彤，张望德，原标，李谈，廖传军，张扬，苑超 摘 要 目的: 探讨肠系膜上动脉(SMA)狭窄/闭塞所致缺血性肠病的诊断和治疗选择。 方法: 5例SMA闭塞的患者采用外科治，15例患者（11例狭窄、4例闭塞）通过介入治疗技术行 SMA球囊扩张及支架植入术。术后常规使用抗血小板药物。17例随访1-32 mo (平均11.5 mo) 结果: 全部病例均在术后1周内症状消失，取得了满意的近期疗效。3例失访，17例随访1-32 个月：1例行支架置入的患者在术后32 mo死于突发心肌梗死, 生存期间腹痛症状未复发；支 架闭塞和支架内约50%的狭窄各1例，但轻度轻微，根据患者的意愿未作进一步处理；3例支架 轻度狭窄（＜30%），无任何腹部不适，暂无需处理；1例因SMA全程闭塞行SMA取栓+肾下腹主 动脉-SMA转流术的患者，术后1年复查时发现人工血管闭塞，但无明显症状且饮食正常，但术 后18个月时突发持续性腹痛，手术探查，经人工血管分别进行人工血管和SMA取栓，术中造影 发现人工血管与SMA吻合口狭窄，吻合口行PTA+球扩支架植入术，次日腹痛缓解，目前正在随 访中。其余患者随访期间均未发现SMA再狭窄/闭塞征象。 结论: CTA, MRA及选择性血管造影对确诊SMA狭窄致肠缺血具有重要意义。 腔内治疗可作为 本病的首选治疗方法；对于SMA闭塞的复杂病例，不同治疗方式的巧妙结合（杂交技术）可以 化繁为简，减少并发症的发生。 关键词: 肠系膜上动脉; 狭窄/闭塞; 腔内介入治疗 Surgical and Endovascular Treatment of Chronic Superior Mesentery Artery Stenosis or Occlusion Abstract OBJECTIVE: To discuss the diagnosis and treatment options for ischemic enteropathy due to superior mesenteric artery (SMA) stenosis or occlusion. METHODS: Five cases with SMA occlusion were treated surgically and 15 cases underwent balloon angioplasty and stent implantation. Post-procedure anticoagulative and antiplatelet therapy were employed routinely. 17 cases were followed up for 3 to 32 months. RESULTS: All patients achieved satisfactory results with disappearance of symptoms within one week postoperatively. Three cases were lost to follow-up and the other 17 cases were observed for 1-32 months: one patient with stent placement died suddenly 32 months postoperatively due to acute myocardial infarction although he was free of abdominal symptoms during follow-up period; Stent occlusion and in-stent stenosis of about 50% were found in 1 case each, and mild in-stent stenosis (＜30%) were present in 3 cases. No further intervention were adopted for t