自發(fā)性孤立性腹腔干動脈夾層的形態(tài)學分型和治療策略
發(fā)布時間：2018-08-24 15:18
【摘要】：目的評估自發(fā)性孤立性腹腔干動脈夾層(spontaneous isolated dissection of the celiac artery, SIDCA)的形態(tài)學調(diào)查結(jié)果和臨床治療經(jīng)驗,希望能夠探索出該疾病的治療策略。方法對自2009年1月至2014年12月的23個在我科就診的自發(fā)性孤立性腹腔干夾層患者進行了回顧性研究,對這一系列患者的人口學數(shù)據(jù)、臨床特征、形態(tài)學研究結(jié)果、治療方法和隨訪結(jié)果進行了評估,并根據(jù)我們之前報道過的自發(fā)性孤立性腸系膜上動脈夾層的形態(tài)學分類,提出了一個關(guān)于自發(fā)性孤立性腹腔干動脈夾層的形態(tài)學分型。結(jié)果在這23例患者中,11位患者接受了血管腔內(nèi)介入治療,12位患者在最初使用了藥物保守治療。在保守治療的患者中,4例患者因為夾層的進展而進行了腔內(nèi)治療的補救。所有接受腔內(nèi)介入治療的病人都在術(shù)后恢復順利,沒有發(fā)生腹痛、再次介入干預及死亡等情況。隨訪結(jié)果顯示,在藥物治療組中,4位患者的夾層假腔完全形成血栓并吸收,2例部分形成血栓,還有2例患者的夾層假腔一直存在；在腔內(nèi)治療組中,所有患者均保持支架內(nèi)血流通暢且假腔完全形成血栓吸收。結(jié)論自發(fā)性孤立性腹腔干動脈夾層是一種罕見的血管性疾病,對于病情穩(wěn)定的患者可以進行藥物的保守治療,但需要進行嚴密的隨訪。對于反復有腹痛等臨床癥狀、內(nèi)臟器官血供灌注不良或形態(tài)學上有夾層動脈瘤形成的高�；颊呖梢詫嵤┭芮粌�(nèi)介入治療。當腔內(nèi)治療不合適或失敗時可以考慮開放手術(shù)。血管腔內(nèi)介入治療的短期結(jié)果是令人鼓舞的,但是長期隨訪來進一步評估治療的效果依然是必須的。
[Abstract]:Objective to evaluate the morphologic findings and clinical treatment experience of spontaneous solitary celiac artery dissection (spontaneous isolated dissection of the celiac artery, SIDCA) in order to explore the treatment strategy of the disease. Methods A retrospective study was conducted on 23 patients with spontaneous and isolated dissection of abdominal cavity from January 2009 to December 2014 in our department. The demographic data, clinical features and morphological findings of these patients were analyzed. The therapeutic methods and follow-up results were evaluated. According to the morphological classification of spontaneous isolated superior mesenteric artery dissection, a morphological classification of spontaneous solitary dissection of the celiac trunk artery was proposed. Results of the 23 patients, 11 received endovascular intervention and 12 received conservative drug therapy initially. Four of the conservative patients underwent endovascular treatment because of the progression of dissection. All patients who received endovascular intervention recovered smoothly without abdominal pain, re-intervention and death. The results of follow-up showed that in the drug treatment group, 4 patients had complete thrombus formation in the dissection and 2 patients had partial thrombus absorption, and 2 patients had always had the dissection false lumen, and in the intracavitary treatment group, In all patients, the blood flow in the stent was patency and thrombus absorption was completely formed in the pseudolumen. Conclusion spontaneous isolated dissection of celiac trunk artery is a rare vascular disease. Patients with stable condition can be treated with medicine conservatively, but should be followed up closely. For the patients with recurrent abdominal pain and other clinical symptoms, the high risk patients with poor blood perfusion of visceral organs or dissecting aneurysms in morphology can be treated with endovascular interventional therapy. Open surgery may be considered when endovascular treatment is inappropriate or fails. The short-term outcome of endovascular intervention is encouraging, but long-term follow-up to further evaluate the effectiveness of treatment is still necessary.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R654.3
[Abstract]:Objective to evaluate the morphologic findings and clinical treatment experience of spontaneous solitary celiac artery dissection (spontaneous isolated dissection of the celiac artery, SIDCA) in order to explore the treatment strategy of the disease. Methods A retrospective study was conducted on 23 patients with spontaneous and isolated dissection of abdominal cavity from January 2009 to December 2014 in our department. The demographic data, clinical features and morphological findings of these patients were analyzed. The therapeutic methods and follow-up results were evaluated. According to the morphological classification of spontaneous isolated superior mesenteric artery dissection, a morphological classification of spontaneous solitary dissection of the celiac trunk artery was proposed. Results of the 23 patients, 11 received endovascular intervention and 12 received conservative drug therapy initially. Four of the conservative patients underwent endovascular treatment because of the progression of dissection. All patients who received endovascular intervention recovered smoothly without abdominal pain, re-intervention and death. The results of follow-up showed that in the drug treatment group, 4 patients had complete thrombus formation in the dissection and 2 patients had partial thrombus absorption, and 2 patients had always had the dissection false lumen, and in the intracavitary treatment group, In all patients, the blood flow in the stent was patency and thrombus absorption was completely formed in the pseudolumen. Conclusion spontaneous isolated dissection of celiac trunk artery is a rare vascular disease. Patients with stable condition can be treated with medicine conservatively, but should be followed up closely. For the patients with recurrent abdominal pain and other clinical symptoms, the high risk patients with poor blood perfusion of visceral organs or dissecting aneurysms in morphology can be treated with endovascular interventional therapy. Open surgery may be considered when endovascular treatment is inappropriate or fails. The short-term outcome of endovascular intervention is encouraging, but long-term follow-up to further evaluate the effectiveness of treatment is still necessary.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R654.3
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本文編號：2201225
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