中文摘要：

目的探讨对急性肠系膜上动脉缺血行腔内介入治疗的有效性和安全性。方法回顾性分析2011年7月至2014年12月重庆医科大学附属第一医院收治的55例急性肠系膜上动脉缺血患者的临床资料。患者术前DSA与CT检查结果一致：肠系膜上动脉主干栓塞34例，肠系膜上动脉分支栓塞17例，肠系膜上动脉夹层并发急性血栓形成4例。患者均首先采用腔内介入治疗；若腹部症状、体征，血常规及影像学检查结果提示肠坏死，则立即行剖腹探查；若术中证实为肠坏死，则行肠切除＋肠吻合术。采用门诊方式进行随访，随访时间截至2015年3月。分析患者腔内介入治疗结果、腔内介入治疗的后续治疗情况、术后并发症、30d病死率、随访期间复发率和病死率。结果55例患者从出现腹部疼痛到行腔内介入治疗的平均间隔时间为10．1h（4．0～15．0h），动脉完全再通率为32．7％（18／55），其中8例肠系膜上动脉主干栓塞，9例肠系膜上动脉分支栓塞，1例肠系膜上动脉主干夹层；部分再通率为63．6％（35／55），其中26例肠系膜上动脉主干栓塞，8例肠系膜上动脉分支栓塞，1例肠系膜上动脉主干夹层；2例肠系膜上动脉夹层患者腔内治疗无效，后行支架置入痊愈。9例肠系膜上动脉主干栓塞患者在腔内介入治疗后11～24h内行剖腹探查＋肠切除＋肠吻合术，切除小肠平均长度为103cm（74～201cm）。患者住院期间均未发生大出血，2例患者出现穿刺点渗血，经压迫止血等处理后好转。55例患者均获得随访，中位随访时间为5个月（2-14个月）。术后1个月内，5例患者死亡，患者30d病死率为9．1％（5／55）；其余患者无腹痛复发。术后5个月，3例患者出现腹痛症状，之后证实非肠系膜动脉缺血所致。2例行支架置入术患者随访9个月未出现复发。其余患者随访期间未出现肠系膜上动脉缺血?

英文摘要：

Objective To investigate the feasibility and safety of endovascular interventional treatment for acute superior mesenterie artery isehemia. Methods The clinical data of 55 patients with acute superior mesenterie artery isehemia who were admitted to the First Affiliated Hospital of Chongqing Medical University from July 2011 to December 2014 were retrospectively analyzed. The result of preoperative digital subtraction angiography （DSA） was in accord with computed tomography （CT） , showing that 34 patients had superior mesenteric artery trunk embolism,17 patients had superior mesenteric artery branch embolism, and 4 patients had artery dissection complicated with acute thrombosis. All patients firstly received endovascular interventional treatment. Abdominal exploration would be done if abdominal symptoms, signs, blood routine and imaging examinations indicated intestinal necrosis. Enterotomy and enteroanastomosis were done when intestinal necrosis was confirmed during the operation. Patients were followed up by outpatient examination till March 2015. The outcomes of endovascular interventional treatment, sequential treatment after endovascular interventional treatment, postoperative complications, 30-day mortality, recurrence rate and mortality during the follow-up were analyzed. Results The median duration from onset of symptoms to endovascular intervention was 10.1 hours （range, 4.0-15.0 hours）. Complete reeanalization rate was 32.7% （18/55） , including 8 cases of superior mesenteric artery trunk embolism, 9 cases of superior mesenteric artery branch embolism and 1 case of superior mesenteric artery dissection. Partial technical recanalization rate 63. 6% （ 35/55 ）, including 26 of superior mesentericartery trunk embolism, 8 cases of superior mesenteric artery branch embolism and 1 case of superior mesenteric artery dissection. Two patients who did not respond to endovascular interventional treatment recovered after stent implantation. Nine patients with superior mesenteric artery trunk embol