30例自发性孤立性肠系膜上动脉夹层的血流动力学分析

Hemodynamic analysis of spontaneous isolated superior mesenteric artery dissection in 30 patients

摘要:

目的：通过对自发性孤立性肠系膜上动脉夹层（spontaneous isolated superior mesenteric artery dissection，SISMAD）腔内治疗和保守治疗前后血流动力学的分析，为2种治疗方法的有效性提供血流动力学依据。方法：回顾性分析2015年11月至2018年3月收治的Ⅰ型、Ⅱ型SISMAD患者30例，腔内治疗组12例，保守治疗组18例，以2组病例的计算机断层扫描血管造影（computed tomography angiography，CTA）图像数据为基础，应用计算流体力学（computational fluid dynamics，CFD）技术分析治疗前后的血流动力学变化。结果：2组病例均得到安全有效的治疗。血流动力学结果显示，入院时夹层段肠系膜上动脉（superior mesenteric artery，SMA）表现为低血流流速流量、高壁面压力、低壁面剪切力（wall shear stress，WSS），最低WSS区域出现在假腔内。腔内治疗术后SMA内血流恢复稳定，壁面压力降低、WSS升高至稳定；而保守治疗中，随着假腔血栓化及血栓吸收，真腔重塑，SMA内血流逐渐恢复稳定，壁面压力逐渐降低、WSS逐渐升高至稳定。结论：Ⅰ型、Ⅱ型SISMAD保守治疗中血流动力学可逐渐恢复至稳定，因此认为保守治疗作为Ⅰ型、Ⅱ型SISMAD的首选治疗方式是安全有效的。

Abstract:

Objective：To analyze the hemodynamics before and after endovascular and conservative treatment for spontaneous isolated superior mesenteric artery dissection（SISMAD），and to provide hemodynamic evidence for effectiveness of the two therapies. Methods：A retrospective analysis was performed on 30 patients with type Ⅰ and type Ⅱ SISMAD from November 2015 to March 2018. The pa－tients were divided into endovascular treatment group（12 patients） and conservative treatment group（18 patients）. Based on imaging data from computed tomography angiography，a computational fluid dynamics analysis was conducted to evaluate hemodynamic changes after treatment in the two groups of patients. Results：Both groups of patients received safe and effective treatment. Hemody－namic results showed low blood flow velocity，high wall pressure，and low wall shear stress（WSS） in the dissected segment of the su－perior mesenteric artery（SMA） on admission，with the lowest WSS in the false lumen. After endovascular treatment，blood flow in the SMA returned to a stable level，the wall pressure decreased，and the WSS increased to a stable state. During the conservative treatment，with false lumen thrombosed and absorbed，the true lumen was remodeled，blood flow in the SMA gradually returned to a stable level，the wall pressure gradually decreased，and the WSS gradually increased to a stable state. Conclusion：Hemodynamic parameters of type Ⅰ and type Ⅱ SISMAD can gradually return to a stable state after conservative treatment，and therefore，conservative treatment，as the preferred strategy for type Ⅰ and type Ⅱ SISMAD，is safe and effective.