目的 探讨急性自发性孤立性内脏动脉夹层（acute spontaneous isolated visceral artery dissection，AVAD）的发病特点及诊治策略。方法 回顾性分析25例AVAD病人临床资料，分析其临床表现、诊疗经过及随访结果。结果 25例AVAD病人（男性100%），平均年龄54.5岁（28~74岁）。初始行腔内治疗（裸支架置入术）的病人1例；开放手术治疗1例；初始接受抗凝、抗血小板治疗的病人共23例，其中16例病人保守治疗1周后腹痛症状明显改善，保守治疗有效率为70%（16/23）。随访期间有5例病人出现夹层进展，转行腔内治疗，1例病人因长期反复的慢性腹痛转行腔内治疗，1例病人发现夹层动脉瘤转为腔内治疗。5例病人在随访期间经历了短期的餐后腹胀情况，后渐缓解。其余病人在随访期间均未出现症状复发，CT血管造影（CTA）随访结果示76%（19/25）病人夹层假腔血栓化，真腔血供改善。结论 抗栓药物的非手术治疗应是AVAD的一线治疗方案，当怀疑肠缺血或夹层病变进展时，腔内治疗是安全可行的治疗方法。弥漫性腹膜炎出现时，应及时手术治疗。
Abstract
Objective To explore the clinical characteristics, diagnosis and treatment strategy of acute spontaneous isolated visceral artery dissection (AVAD).Methods 25 patients with AVAD were collected retrospectively. Clinical features, treatment modalities, and follow-up results were reviewed according to medical records.Results Twenty-five patients (100% male) with AVAD had a mean age of 54.5 years (28 to 74 years).One patient initially underwent endovascular treatment (bare stent implantation); 1 patient was treated with open surgery; 23 patients initially received anticoagulant and antiplatelet therapy, of which 16 patients had significant improvement in abdominal pain symptoms after one week of conservative treatment, with a conservative treatment response rate of 70% (16/23). During the follow-up period, 5 patients had dissection progression and were converted to endovascular treatment, 1 patient was converted to endovascular treatment due to long-term recurrent chronic abdominal pain, and 1 patient was found to have dissecting aneurysm and was converted to endovascular treatment.Five patients experienced short-term abdominal distension during follow-up, which gradually resolved. The other patients had recurrence of symptoms during follow-up. CTA follow-up results showed that 76% (19/25) of patients had thrombosis of the dissecting false lumen and the true lumen was improved.Conclusion Conservative management with antithrombotic agents should be a first-line regimen for AVAD. If intestinal ischemia and dissection progression are suspected, endovascular intervention is a safe and feasible treatment. When diffuse peritonitis is present, surgical treatment should be promptly performed.
关键词
内脏动脉 /
夹层 /
腹痛
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Key words
Visceral artery /
Dissection /
Abdominal pain
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中图分类号：
R657.2
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参考文献
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