介入治疗孤立性腹腔干夹层4例

【摘要】　目的?探讨介入治疗孤立性腹腔干夹层（IDCA）的效果和安全性。方法?回顾性分析 4例IDCA患者临床和影像学资料。根据孙捷等IDCA分型，Ⅱa型2例，Ⅲb型2例，均因内科保守治疗效果不佳接受介入治疗。2例Ⅱa型患者于腹腔干植入裸支架或覆膜支架1枚，2例Ⅲb型患者于腹腔干及分支内植入覆膜支架和裸支架各1枚。术后给予低分子肝素抗凝3 d，口服氯吡格雷。结果?4例患者手术均成功，术后1周腹痛症状消失，未发生围手术期出血、感染、夹层破裂等并发症。随访6～27个月，4例腹痛症状均未复发，支架均通畅；1例支架移位，3例支架位置良好。结论?支架植入术治疗IDCA安全有效。对低风险IDCA患者首选保守治疗，保守治疗效果不佳者宜选择介入治疗。

Interventional treatment for isolated celiac artery dissection:preliminary results in 4 patients

Objective To discuss the effect and safety of interventional treatment for isolated dissection of the celiac artery(IDCA).Methods The clinical data and imaging materials of 4 patients with IDCA were retrospectively analyzed.According to tje classification of IDCA proposed by SUN Jie,et al.,2 patients were classified inⅡa type and the other 2 patients were classified inⅢb type.All the 4 patients received interventional therapy because the conservative treatment showed poor response.In 2 patients withⅡa type IDCA,implantation of bare stent or covered stent in the celiac artery was carried out respectively.In the other 2 patients with typeⅢb type IDCA,implantation of both bare stent and covered stent in the celiac artery and its branch was employed.After treatment,anticoagulation with low molecular weight heparin(LMWH)was adopted for 3 days,and clopidogrel was orally given.Results Successful interventional procedure was accomplished in all 4 patients.One week after treatment,the symptoms of abdominal pain disappeared,and no perioperative complications such as bleeding,infection,rupture of dissection,etc.occurred.Patients were followed-up for 7-27 months,no recurrence of abdominal pain was observed in all the 4 patients,and all the implanted stents were unobstructed.Displacement of stent was seen in one patient,and the stents were stably in right position in 3 patients.Conclusion For the treatment of IDCA,stent implantation is a safe and effective method.For low-risk IDCA patients,conservative treatment should be adopted as the therapy of first choice,while for IDCA patients who have poor response to conservative treatment,interventional endovascular repair is an appropriate choice.