孤立性肠系膜上动脉夹层保守治疗成功的预测因素分析
| 作者: |
1承文龙,
1卢辉俊
1 南京医科大学附属无锡市人民医院 血管外科，江苏 无锡 214000 |
| 通讯: |
卢辉俊
Email: cwl0620@163.com |
| DOI: | 10.3978/.2018.06.009 |
| 基金: | 国家自然科学基金资助项目（81572783）。 |
摘要
目的：探讨孤立性肠系膜上动脉夹层（ISMAD）保守治疗成功的预测因素。
方法：回顾性分析 2012 年 1 月—2017 年 3 月收治的 37 例 ISMAD 患者的临床资料，其中 18 例行保守治疗成功，19 例保守治疗失败，比较两组患者中的相关因素，筛选出有统计学差异的预测因素。
结果：与保守治疗失败患者比较，保守治疗成功患者在年龄、病程方面差异无统计学意义（均P>0.05）；保守治疗成功较失败者，腹主动脉 - 肠系膜上动脉夹角（SAA）≤ 75°的患者比例明显减少（27.8% vs. 63.2%，P<0.05）、平均夹层距离明显增大（2.34 cm vs. 1.47 cm，P<0.01）、平均夹层长度明显减小（3.13 cm vs. 4.57 cm，P<0.05）、平均真腔狭窄率明显减少（33.9% vs. 65.8%，P<0.01）。
结论：SAA>75°、夹层距离较长、夹层长度较小及真腔狭窄度较小是 ISMAD 保守治疗成功的预测因素。当保守治疗失败时，可选择安全有效的腔内治疗。
关键词：
动脉瘤，夹层；肠系膜动脉；保守治疗；血管内操作；影响因素分析
方法：回顾性分析 2012 年 1 月—2017 年 3 月收治的 37 例 ISMAD 患者的临床资料，其中 18 例行保守治疗成功，19 例保守治疗失败，比较两组患者中的相关因素，筛选出有统计学差异的预测因素。
结果：与保守治疗失败患者比较，保守治疗成功患者在年龄、病程方面差异无统计学意义（均P>0.05）；保守治疗成功较失败者，腹主动脉 - 肠系膜上动脉夹角（SAA）≤ 75°的患者比例明显减少（27.8% vs. 63.2%，P<0.05）、平均夹层距离明显增大（2.34 cm vs. 1.47 cm，P<0.01）、平均夹层长度明显减小（3.13 cm vs. 4.57 cm，P<0.05）、平均真腔狭窄率明显减少（33.9% vs. 65.8%，P<0.01）。
结论：SAA>75°、夹层距离较长、夹层长度较小及真腔狭窄度较小是 ISMAD 保守治疗成功的预测因素。当保守治疗失败时，可选择安全有效的腔内治疗。
Analysis of predictive factors for success of conservative treatment of isolated superior mesenteric artery dissections
CorrespondingAuthor:LU Huijun Email: cwl0620@163.com
Abstract
Objective: To investigate the predictive factors for the success of conservative treatment of isolated superior mesenteric artery dissections (ISMAD).
Methods: The clinical data of 37 patients with ISMAD admitted from January 2012 to March 2017 were retrospectively analyzed. Of the patients, conservative treatment was successful in 18 cases, and failed in 19 patients. The relevant factors were compared between the two groups of patients to determine the predictive factors for the success of conservative treatment.
Results: In patients having successful conservative treatment compared with those who had unsuccessful conservative treatment, the age and course of disease showed no statistical difference (both P>0.05), while the proportion of cases with superior mesenteric artery-distal aorta angle (SAA) less than or equal to 75° was signifi cantly decreased (27.8% vs. 63.2%, P<0.05), the average distance of dissection was signifi cantly prolonged (2.34 cm vs. 1.47 cm, P<0.01), the length of dissection was signifi cantly shorter (3.13 cm vs. 4.57 cm, P<0.05), and the average degree of true lumen stenosis was significantly smaller (33.9% vs. 65.8%, P<0.01).
Conclusion: SAA greater than 75°, relatively long distance of dissection, relatively short length of dissection and relatively small degree of true lumen stenosis are the predictors for success of conservative treatment of ISMAD. When conservative treatment is unsuccessful, safe and effective endovascular therapy can be selected.
Keywords：
Aneurysm
Dissecting; Mesenteric Arteries; Conservative Treatment; Endovascular Procedures; Root Cause Analysis
Methods: The clinical data of 37 patients with ISMAD admitted from January 2012 to March 2017 were retrospectively analyzed. Of the patients, conservative treatment was successful in 18 cases, and failed in 19 patients. The relevant factors were compared between the two groups of patients to determine the predictive factors for the success of conservative treatment.
Results: In patients having successful conservative treatment compared with those who had unsuccessful conservative treatment, the age and course of disease showed no statistical difference (both P>0.05), while the proportion of cases with superior mesenteric artery-distal aorta angle (SAA) less than or equal to 75° was signifi cantly decreased (27.8% vs. 63.2%, P<0.05), the average distance of dissection was signifi cantly prolonged (2.34 cm vs. 1.47 cm, P<0.01), the length of dissection was signifi cantly shorter (3.13 cm vs. 4.57 cm, P<0.05), and the average degree of true lumen stenosis was significantly smaller (33.9% vs. 65.8%, P<0.01).
Conclusion: SAA greater than 75°, relatively long distance of dissection, relatively short length of dissection and relatively small degree of true lumen stenosis are the predictors for success of conservative treatment of ISMAD. When conservative treatment is unsuccessful, safe and effective endovascular therapy can be selected.