摘要:Objective To explore the clinical characteristics, diagnosis and treatment of isolated superior mesenteric artery dissection (ISMAD). Methods From June 2008 to June 2013, 12 patients with ISMAD were treated in our center, and all cases were diagnosed by contrast-enhanced computed tomography (CT) or CT angiography (CTA). Management strategies included surgery, endovascular therapy, catheter-directed thrombolysis, conservative treatment and observation. Results Two cases without ISMAD related abdominal pain were observed. Among 10 symptomatic patients, 5 underwent conservative treatment, 1 endovascular repair, 1 emergency exploratory laparotomy and secondary endovascular repair, 2 only catheter-directed thrombolyisis, 1 catheter-directed thrombolyisis and then endovascular therapy. After management, abdominal pain relieved in different degrees. All cases were followed up with a time of 2~60 (mean, 16.8±12.3) months. During the follow-up, there was no recurrent abdominal pain, no dissection enlargement or thrombus increase of SMA. Stents were patent in cases underwent endovascular stenting. Conclusions Because of lack of manifestation specificity of ISMAD, the diagnosis needs to be confirmed by CT or CTA. Conservative treatment appears to be feasible and effective. For those who still have abdominal pain, have a trend to suffer from the rupture of SMA or the mesenteric ischemia, if the conservative treatment do not work,endovascular therapy will be performed in time.%目的:探讨孤立性肠系膜上动脉夹层(ISMAD)的病例特点及诊治策略。方法分析2008年6月至2013年6月本院收治的12例ISMAD患者的临床资料。患者均经腹部增强CT或者CT血管造影(CTA)检查明确诊断。治疗方法包括观察治疗、保守治疗、置管溶栓、腔内治疗以及手术治疗等。结果2例没有出现ISMAD相关腹痛症状的患者予以观察治疗。10例有症状的患者中,5例采用保守治疗,1例采用腔内治疗,1例急诊剖腹探查后行手术治疗,再行二期的腔内治疗,2例单纯采用置管溶栓治疗,1例采用置管溶栓后腔内治疗,腹痛症状均得到不同程度的缓解。患者均得到随访,随访时间2~60个月,平均(16.8±12.3)月,患者无腹痛复发,未见夹层范围扩大及血栓增多,腔内治疗的患者支架通畅。结论 ISMAD的症状缺乏特异性,有赖于增强CT或者CTA明确诊断,保守治疗为ISMAD行之有效的治疗方法,对于保守治疗效果较差、预计血管破裂、肠缺血可能性大的患者,应及时予以腔内治疗。