摘要
64岁女性患者,既往有房颤、冠心病、冠状动脉支架植入、主动脉瓣及二尖瓣置换术病史。主因间断腹痛1年、再次发作伴便血2 d收住消化科。患者1年前被诊断急性肠系膜缺血(AMI),行肠系膜上动脉(SMA)支架植入术及球囊扩张成形术,本次入院CT明确缺血性肠病。经多学科会诊,血管造影证实SMA支架内再狭窄,行球囊扩张成形术及支架植入术。因伴横结肠坏死,同期行受累横结肠切除术及结肠造口术。术后随访,9个月后患者再发AMI,经再次SMA球囊扩张成形术,术后患者病情稳定。本例患者的诊治经验为反复AMI高危人群的识别、治疗方式选择及长期随访管理提供了一定的参考。
A 64-year-old female patient had a history of atrial fibrillation,coronary heart disease,coronary artery stenting,aortic valve replacement,and mitral valve replacement.She was admitted to the Department of Gastroenterology due to intermittent abdominal pain for 1 year and recurrence of pain accompanied by hematochezia for 2 days.One year prior,she was diagnosed with acute mesenteric ischemia(AMI)and underwent superior mesenteric artery(SMA)stenting and balloon angioplasty.During this admission,abdominal CT confirmed ischemic bowel disease.After multidisciplinary consultation,angiography verified in-stent restenosis of the SMA,and the patient underwent balloon angioplasty and stenting again.Due to concurrent transverse colon necrosis,she also received resection of the involved transverse colon and colostomy in the same operation.During postoperative follow-up,the patient experienced another episode of AMI 9 months later.After undergoing SMA balloon angioplasty for the third time,her condition remained stable.The diagnostic and therapeutic experience of this case provides certain reference for the identification of high-risk populations with recurrent AMI,the selection of treatment modalities,and long-term follow-up management.
作者
郑可心
程艳丽
ZHENG Kexin;CHENG Yanli(Department of Gastroenterology,the First Hospital of Tsinghua University,Beijing 100016,China)
关键词
缺血
肠系膜上动脉
血管假体植入
支架内再狭窄
多学科诊疗
Ischemia
Mesenteric artery,superior
Blood vessel prosthesis implantation
In-stent restenosis
Multidisciplinary teamonsultation
