Lian Li-Shan, Wu Zhi-Yuan, Zhang Zhe, Feng Hai, Li Yong-Jun
Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China.
Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, PR China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
Ann Vasc Surg. 2023 May;92:42-48. doi: 10.1016/j.avsg.2023.01.019. Epub 2023 Feb 1.
To present 5-year results of management on spontaneous isolated superior mesenteric artery dissection (SISMAD) from 2 teaching hospitals in China.
The clinical data of 41 patients with SISMAD were retrospectively collected from 2 teaching hospitals between December 2016 and December 2021. Therapeutic methods mainly included open surgery, endovascular management, and conservative therapy. Patients' demographics, total number of WBC (White blood cell, WBC), the percentage of NEUT (Neutrophil), the level of CRP (C-reactive protein, CRP), duration of abdominal pain on admission, YOO classification of SISMAD, angle of superior mesenteric artery to abdominal aorta (ASA), length of hospital stays, and vascular remodeling rate of SMA between endovascular and conservative groups were analyzed.
A total of 41 patients with SISMAD were finally included in this study. Their average age was 53.4 ± 7.1 years old, ranging from 35 to 68 years old. Among these patients, 1 patient suffered emergent open surgery because of the intestinal necrosis. The other 40 patients were treated conservatively at first, but 13 of them were transitioned into endovascular management due to persistent abdominal pain. Regarding the imaging analysis, IIS and IVS types of YOO classification were more in the endovascular group (13 patients) than the conservative group (27 patients). The length of hospital stays (P = 0.003) and the vascular remodeling rate of SMA were significantly different between 2 groups (P = 0.002), while the time of abdominal pain on admission, the infection markers (WBC, CRP, NEUT) and ASA were not significantly different between the 2 groups.
In SISMAD, patients without any signs of peritonitis and intestinal necrosis may be treated conservatively firstly, and then transitioned into endovascular management if abdominal pain is not improved within 48 hr. IIS and IVS types of YOO classification should be alerted of this potential transition. But the optimal timing of transition required more clinical studies.
呈现中国两家教学医院对自发性孤立性肠系膜上动脉夹层（SISMAD）的5年管理结果。
回顾性收集2016年12月至2021年12月期间两家教学医院41例SISMAD患者的临床资料。治疗方法主要包括开放手术、血管内治疗和保守治疗。分析患者的人口统计学特征、白细胞总数（WBC）、中性粒细胞百分比（NEUT）、C反应蛋白（CRP）水平、入院时腹痛持续时间、SISMAD的YOO分类、肠系膜上动脉与腹主动脉夹角（ASA）、住院时间以及血管内治疗组和保守治疗组之间肠系膜上动脉的血管重塑率。
本研究最终纳入41例SISMAD患者。他们的平均年龄为53.4±7.1岁，年龄范围为35至68岁。在这些患者中，1例因肠坏死接受了急诊开放手术。其他40例患者首先接受保守治疗，但其中13例因持续性腹痛转为血管内治疗。关于影像学分析，YOO分类中的IIS型和IVS型在血管内治疗组（13例患者）中比保守治疗组（27例患者）更多。两组之间的住院时间（P = 0.003）和肠系膜上动脉的血管重塑率有显著差异（P = 0.002），而入院时腹痛时间、感染指标（WBC、CRP、NEUT）和ASA在两组之间无显著差异。
在SISMAD中，无任何腹膜炎和肠坏死迹象的患者可首先接受保守治疗，若48小时内腹痛未改善则转为血管内治疗。YOO分类的IIS型和IVS型应警惕这种潜在转变。但转变的最佳时机需要更多临床研究。
