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浙江大学学报（医学版）
浙江大学学报（医学版）  2020, Vol. 49 Issue (3): 383-388    DOI: 10.3785/j.issn.1008-9292.2020.06.05
原著     
孤立性自发性肠系膜上动脉夹层腔内治疗的前瞻性单臂临床研究初步结果
孙缙红1,2(),邱宸阳1,吴子衡1,张鸿坤1,*()
1. 浙江大学医学院附属第一医院血管外科, 浙江 杭州 310003
2. 丽水市中心医院血管外科, 浙江 丽水 323000
Preliminary result of stents implantation for spontaneous isolated dissection of the superior mesenteric artery: a prospective single-arm study
SUN Jinhong1,2(),QIU Chenyang1,WU Ziheng1,ZHANG Hongkun1,*()
1. Department of Vascular Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
2. Department of Vascular Surgery, the Central Hospital of Lishui City, Lishui 323000, Zhejiang Province, China
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摘要：

目的: 探讨腔内治疗在孤立性自发性肠系膜上动脉夹层中的有效性。方法: 本研究为北美临床试验注册中心（Clinical Trials）注册的前瞻性单臂观察性研究（NCT03916965）。收集2019年4月1月至2019年9月30日在浙江大学医学院附属第一医院接受支架植入治疗的肠系膜上动脉夹层患者的临床资料及随访信息。术后建议患者1、3、6和12个月时门诊随访。结果: 总计有34例患者入组随访队列，平均年龄为（54±8）岁，最常见的临床表现为腹痛。平均每例患者植入（2.1±0.6）枚支架，术后平均住院日为（2.7±1.6）d。平均CT血管造影随访时间为（2.3±1.9）个月，门诊或电话随访时间为（5.5±1.7）个月，所有患者均无腹痛再发。33例患者影像学随访结果显示，23例（69.7%）患者夹层完全塑形，9例（27.3%）患者部分塑形，1例（3.0%）患者无变化，且无支架移位、断裂；2例（6.1%）患者出现无须干预的支架内轻度狭窄，余患者支架通畅。结论: 腔内治疗孤立性自发性肠系膜上动脉夹层短期效果确切，有望成为一线治疗手段。
关键词： 肠系膜上动脉;  动脉夹层;  腔内治疗;  前瞻性;  治疗结果    
Abstract:

Objective: To access the efficacy of stents for spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). Method: The study is a prospective single-arm study which has been registered on Clinical Trials (NCT03916965). Clinical data and follow-up information of the SIDSMA patients who received stent implantation in the First Affiliated Hospital of Zhejiang University during April 1, 2019 and September 30, 2019 were collected. The patients were recommended to be followed up at 1, 3, 6 and 12 months. Results: A total of 34 patients were enrolled. Their mean age was (54±8) years. Abdominal pain was the most common symptom. Patients received (2.1±0.6) stents on the average. Post-operation hospital stay was (2.7±1.6) days, and the patients were followed up for (2.3±1.9) months (CT angiography) and (5.5±1.7) months (clinical visit/phone call). There was no recurrence of abdominal pain. The CT angiography showed complete remodeling and incomplete remodeling took place in 23 and 9 patients (69.7% and 27.3%), respectively. Two patients (6.1%) had mild in-stent stenosis. No stent rupture or migration was reported. Conclusion: This study demonstrated a satisfactory short-term result of stents implantation for SIDSMA, which indicated the endovascular treatment could be the first-line therapy for SIDSMA.
Key words: Mesenteric artery, superior    Artery dissection    Endovascular treatment    Prospective    Treatment outcome
收稿日期: 2019-12-29 出版日期: 2020-07-24
CLC:  R654  
通讯作者: 张鸿坤     E-mail: yazeixiangku@163.com;1198050@zju.edu.cn
作者简介: 孙缙红(1987—), 女, 硕士研究生, 主治医师, 主要从事外周血管疾病及血液透析用通路研究; E-mail:yazeixiangku@163.com; https://orcid.org/0000-0002-6748-210X
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引用本文:

孙缙红,邱宸阳,吴子衡,张鸿坤. 孤立性自发性肠系膜上动脉夹层腔内治疗的前瞻性单臂临床研究初步结果[J]. 浙江大学学报（医学版）, 2020, 49(3): 383-388.

SUN Jinhong,QIU Chenyang,WU Ziheng,ZHANG Hongkun. Preliminary result of stents implantation for spontaneous isolated dissection of the superior mesenteric artery: a prospective single-arm study. J Zhejiang Univ (Med Sci), 2020, 49(3): 383-388.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2020.06.05    或    http://www.zjujournals.com/med/CN/Y2020/V49/I3/383

图 1  孤立性自发性肠系膜上动脉夹层腔内治疗后典型病例CT血管造影图
1 LUAN J Y , GUAN X , LI X et al. Isolated superior mesenteric artery dissection in China[J]. J Vasc Surg, 2016, 63 (2): 530- 536
doi: 10.1016/j.jvs.2015.09.047
2 BJ?RCK M , KOELEMAY M , ACOSTA S et al. Editor's choice-management of the diseases of mesenteric arteries and veins:clinical practice guidelines of the European Society of Vascular Surgery (ESVS)[J]. Eur J Vasc Endovasc Surg, 2017, 53 (4): 460- 510
doi: 10.1016/j.ejvs.2017.01.010
3 WANG J , HE Y , ZHAO J et al. Systematic review and meta-analysis of current evidence in spontaneous isolated celiac and superior mesenteric artery dissection[J]. J Vasc Surg, 2018, 68 (4): 1228- 1240
4 HEO S H , KIM Y W , WOO S Y et al. Treatment strategy based on the natural course for patients with spontaneous isolated superior mesenteric artery dissection[J]. J Vasc Surg, 2017, 65 (4): 1142- 1151
doi: 10.1016/j.jvs.2016.10.109
5 QIU C , HE Y , LI D et al. Mid-term results of endovascular treatment for spontaneous isolated dissection of the superior mesenteric artery[J]. Eur J Vasc Endovasc Surg, 2019, 58 (1): 88- 95
doi: 10.1016/j.ejvs.2018.11.013
6 GHODASARA N , LIDDELL R , FISHMAN E K et al. High-value multidetector CT angiography of the superior mesenteric artery:what emergency medicine physicians and interventional radiologists need to know[J]. Radiographics, 2019, 39 (2): 559- 577
doi: 10.1148/rg.2019180131
7 AHN S , MO H , HAN A et al. The use of antithrombotics is not beneficial for conservative management of spontaneous isolated dissection of the superior mesenteric artery:a meta-analysis[J]. Ann Vasc Surg, 2019, 60 415- 423
8 ZHU Y , PENG Y , XU M et al. Treatment strategies and outcomes of symptomatic spontaneous isolated superior mesenteric artery dissection:a systematic review and meta-analysis[J]. J Endovasc Ther, 2018, 25 (5): 640- 648
doi: 10.1177/1526602818796537
9 ULLAH W , MUKHTAR M , ABDULLAH H M et al. Diagnosis and management of isolated superior mesenteric artery dissection:a systematic review and meta-analysis[J]. Korean Circ J, 2019, 49 (5): 400- 418
doi: 10.4070/kcj.2018.0429
10 XIAO Q Z , HAO M , LIN L et al. Clinical and CT angiographic follow-up outcome of spontaneous isolated intramural hematoma of the superior mesenteric artery[J]. Cardiovasc Intervent Radiol, 2019, 42 (8): 1088- 1094
doi: 10.1007/s00270-019-02212-x
11 KIM H , PARK H , PARK S J et al. Outcomes of spontaneous isolated superior mesenteric artery dissection without antithrombotic use[J]. Eur J Vasc Endovasc Surg, 2018, 55 (1): 132- 137
doi: 10.1016/j.ejvs.2017.11.002
12 FANG G , XU G , FANG Y et al. Primary conservative treatment for peritonitis-absent symptomatic isolated dissection of the superior mesenteric artery with severely compressed true lumen[J]. Vascular, 2020, 28 (2): 132- 141
doi: 10.1177/1708538119892751
13 LIU B , CHU C , FAN X et al. Endovascular stent placement for isolated superior mesenteric artery dissection with intestinal ischaemia[J]. Vasa, 2019, 48 (1): 73- 78
doi: 10.1024/0301-1526/a000738
14 WU Z , YI J , XU H et al. The significance of the angle between superior mesenteric artery and aorta in spontaneous isolated superior mesenteric artery dissection[J]. Ann Vasc Surg, 2017, 45 117- 126
doi: 10.1016/j.avsg.2017.06.156
15 ZHANG X , XIANG P , YANG Y et al. Correlation between computed tomography features and clinical presentation and management of isolated superior mesenteric artery dissection[J]. Eur J Vasc Endovasc Surg, 2018, 56 (6): 911- 917
doi: 10.1016/j.ejvs.2018.08.037
16 KIMURA Y , KATO T , NAGAO K et al. Outcomes and radiographic findings of isolated spontaneous superior mesenteric artery dissection[J]. Eur J Vasc Endovasc Surg, 2017, 53 (2): 276- 281
doi: 10.1016/j.ejvs.2016.11.012
17 JANG J H , CHO B S , AHN H Y et al. Optimal treatment strategy and natural history of isolated superior mesenteric artery dissection based on long-term follow-up CT findings[J]. Ann Vasc Surg, 2020, 63 179- 185
doi: 10.1016/j.avsg.2019.08.092
18 LOEFFLER J W , OBARA H , FUJIMURA N et al. Medical therapy and intervention do not improve uncomplicated isolated mesenteric artery dissection outcomes over observation alone[J]. J Vasc Surg, 2017, 66 (1): 202- 208
doi: 10.1016/j.jvs.2017.01.059
19 MIZUNO A , IGUCHI H , SAWADA Y et al. Real clinical management of patients with isolated superior mesenteric artery dissection in Japan[J]. J Cardiol, 2018, 71 (2): 155- 158
doi: 10.1016/j.jjcc.2017.08.006
20 BEN ABDALLAH I , EL BATTI S , HUGUET A et al. Conservative therapy vs. extensive stenting in superior mesenteric artery dissection:the right balance remains to be found[J]. Eur J Vasc Endovasc Surg, 2019, 57 (4): 603
doi: 10.1016/j.ejvs.2018.11.021
21 JIA Z , SU H , CHEN W et al. Endovascular treatment of patients with isolated mesenteric artery dissection aneurysm:bare stents alone versus stent assisted coiling[J]. Eur J Vasc Endovasc Surg, 2019, 57 (3): 400- 406
doi: 10.1016/j.ejvs.2018.08.057
22 KIM J , YOON C J , SEONG N et al. Spontaneous dissection of superior mesenteric artery:long-term outcome of stent placement[J]. J Vasc Interv Radiol, 2017, 28 (12): 1722- 1726
doi: 10.1016/j.jvir.2017.05.022
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