肠系膜静脉血栓形成

本文对收治的4例肠系膜静脉血栓形成导致肠坏死的病例进行复习。其中3例伴有易感因素。此病一般病程较长且临床表现不典型。在肠管坏死前,腹部疼痛与查体所见不成比例。腹部膨隆及腹膜刺激征则为本病晚期的表现。腹腔诊断性穿刺抽出浆液血性液有助于诊断。腹部X 线平片常显示为肠梗阻的X 线征。手术如发现肠管已坏死,切除应包括足够的正常肠管及其系膜,以避免术后复发。本文还对肠系膜静脉切开取栓及术后抗凝疗法的应用进行讨论。     

肠系膜静脉血栓形成

肠系膜静脉血栓形成(Mesenteric Ve-nous Thrombosis MVT)是一种临床罕见的肠系膜血管闭塞性疾病。许多临床医生对其了解甚少,加之本病的临床症状及体征尚无特异性表现,故很难在术前或死前明确诊断,更难做到早期诊断和治疗。由于上述原因,往往延误治疗,造成本病的死亡率过     

肠系膜静脉血栓形成

肠系膜静脉血栓形成是少见疾病，一旦发生后果严重。由于其临床表现无特异性，多于手术中才能作出正确诊断。近来因新的影像技术的应用，在出现肠梗塞前作出诊断已成为可能，非手术治疗亦有成功的报告。本院20年来收治4例该病患者，现报告如下。1临床资料例1女，33岁。脐周隐痛1周，伴腹泻2～3次／天，黄色烂便，腹痛加重，持续性阵发性加剧18小时，有呕吐胃内容物，肌注杜冷丁不能止痛而入院。体查：P100次／分，BP13／8kPa。腹稍胀，肌紧张，全腹均有压痛及反跳痛，肠鸣音减弱。腹穿抽出血性腹液。即剖腹探查，见腹内有血性液体，距回育…     

全直肠系膜切除术

全直肠系膜切除术(TME)最早由Heald在1982年提出，经过20多年的实践，已经得到越来越多外科同行的认可，在欧洲已成为直肠癌手术的“金标准”。     

肠系膜淋巴管瘤

患者,男,25岁,已婚。无明显诱因发现左下腹有一约鹅蛋大小呈椭圆形肿物,质地中等硬,无触痛。肿物在腹腔内游走,门诊以腹腔肿物性质待查收住院。患病后精神饮食好。查体:体温36℃,脉搏78/分,呼吸20/分,血压16/10kPa,发育正常,营养中等,皮肤巩膜未见黄染,表浅淋巴结未触及,心肺未见异常。腹软,左下腹可触及拳头大小肿物,触之疼痛,活动度大,中等硬度。心电图正常。B型超声腹腔混合性肿物。全消化道造影:考虑腹腔占位病变。化     

肠系膜静脉血栓的研究进展

肠系膜静脉血栓(MVT)是造成肠系膜缺血的一种疾病,引起肠壁营养障碍及运动障碍,MVT发病率低于其他血管疾病,但临床常因缺乏及时有效的诊断及治疗,病死率极高。MVT形成分为原发性MVT和继发性MVT两类,原发性MVT常无明确诱因,继发性MVT形成常继发于血液高凝状态、门静脉高压、腹腔内脏感染、创伤及手术,实验室检查常不能提供早期诊断线索,随着增强CT、超声、血管造影、核磁等辅助检查技术的发展,使MVT的早期诊断成为可能,早期有效的抗凝、溶栓治疗,降低了肠管坏死风险,使外科手术概率及死亡率下降。现就MVT的流行病学、发病原因、病理变化、临床表现、诊断及治疗的研究情况概述如下。     

彩超诊断肠系膜及肠系膜上动脉扭转1例

患者男，68岁，因上腹部隐痛2个月，加重伴呕吐1d入院查体：生命体征平稳。痛苦面容，腹平坦，腹肌稍紧，剑突下、右上腹压痛明显，无反跳痛，未扪及明显包块回声，肠鸣音减弱。CT检查动脉期见肠系膜上动脉上段较粗，下段弯曲变细不明显，     

肠系膜血栓形成3例

肠系膜血栓形成３例水电部十三局医院内科刘治军病例报告例１：男，７３岁。因心慌、胸闷５天，上腹痛２天于１９８９年１月１８日入院。患者５天前因劳累感心慌、胸闷，心前区隐痛，服冠脉扩张药后病情稍好转。２天前感上腹胀痛，进食后腹痛加剧，呕吐３次，为胃内容物及...     

直肠癌全直肠系膜切除术

目的 比较全直肠系膜切除(TME)和传统手术方法对直肠癌术后局部复发及近期生存率的影响。方法 将采用TME的直肠癌患者62例与行传统切除方法的57例患者进行比较，分析两组的临床参数。结果 TME组的局部复发率显著低于传统手术组，而近期生存率显著高于传统手术组。结论 采用TME技术能有效降低直肠癌的局部复发率及提高患者生存率。     

Congenital mesenteric aneurysm and mesenteric arterioportal fistula

A unique case with superior mesenteric artery aneurysm and arterioportal fistula resulting from mesenteric arteriovenous malformation is presented, and the relevant literature is reviewed. Received: 16 December 1994/Accepted after revision: 31 March 1995     

Chronic mesenteric ischemia: stenting of mesenteric arteries

This article focuses on stent placement in mesenteric arteries in patients with the rare diagnosis of chronic mesenteric ischemia. We present a survey from the initial stage of recognition of this gastrointestinal disorder and its manifestations to treatment by stenting to avoid further ischemic episodes and bowel infarction and necrosis. The advantages of stent placement in splanchnic arteries are discussed in comparison to open surgical revascularization.     

Intravenous iloprost increases mesenteric blood flow in experimental acute nonocclusive mesenteric ischemia

OBJECTIVE: To evaluate the effect of an intravenously administered synthetic epoprostenol analog, iloprost, in nonocclusive acute mesenteric ischemia induced by cardiac tamponade. DESIGN: Prospective, randomized, controlled experimental study. SETTING: Animal research laboratory at a university medical center. SUBJECTS: Ten Yorkshire pigs (weight range, 20-25 kg). INTERVENTIONS: Nonocclusive acute mesenteric ischemia was induced by pericardial tamponade. Pigs were randomized to receive either a low-dose, continuous intravenous infusion of iloprost (0.075 microg/kg/min) or an equivalent volume of normal saline to serve as the control. Infusion of iloprost or saline was continued after pericardial tamponade was reversed. METHODS: Ten anesthetized and ventilated pigs underwent laparotomy and thoracotomy. A pulmonary artery catheter was inserted, a magnetic flow probe was positioned around the superior mesenteric artery (SMA), and cannulation of the pericardial space was performed. Pericardial tamponade was induced by injecting 5% dextrose in water into the pericardial space until blood flow in the superior mesenteric artery decreased to half of baseline. After 60 mins, animals received either a continuous intravenous infusion of iloprost at 0.075 microg/kg/min (n = 6) or an equal volume of normal saline (n = 4) for 60 mins. Pericardial fluid was then removed, and iloprost or normal saline infusion was continued for another 60 mins. MEASUREMENTS: Heart rate, blood pressure, cardiac output, oxygen delivery, oxygen consumption, SMA blood flow, ileal Pco2, ileal intramucosal pH, and serum lactate levels of mixed venous blood and mesenteric venous blood were recorded at baseline, after pericardial tamponade was induced, during the iloprost or normal saline infusion with pericardial tamponade, and after removal of pericardial fluid (reperfusion period). RESULTS: Iloprost infusion increased SMA blood flow by 60% in this model of nonocclusive mesenteric ischemia (from 168 +/- 41 to 269 +/- 76 mL/min; p <.05). The effect of iloprost infusion was more prominent after the tamponade (422 +/- 87 mL/min in the iloprost group vs. 232 +/- 111 mL/min in the control group; p <.05). Increased mesenteric perfusion decreased intestinal mucosal hypercarbia, leading to improvement of intramucosal pH.     

Recurrent retroperitoneal mesenteric cyst

A mesenteric cyst is an uncommon cause of a palpable abdominal mass. A correct preoperative diagnosis can be made by the combined use of radiographic and sonographic examinations in conjunction with the clinical features. A patient with a retroperitoneal cyst extending into the leaves of the mesentery is presented. The cyst recurred 4 years after surgery.     

Intra-abdominal mesenteric desmoid tumor

We have presented a case of mesenteric desmoid tumor, with analysis of 21 such cases previously reported in Japan.     

Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography

The purpose of this study was to explore the accuracy of multi-detector row helical CT (MDCT), using a biphasic mesenteric angiography protocol for evaluation of acute mesenteric ischemia (AMI). In total, 79 consecutive patients with clinical signs of AMI underwent contrast enhanced 16- or 40-channel MDCT. MDCT findings were correlated with surgery, endoscopy and clinical outcome. Sensitivity, specificity, and positive and negative predictive values were calculated using the patients in which AMI had been excluded as a control group. In 28 patients the final diagnosis was AMI. In 27 patients (96.4%) MDCT correctly diagnosed AMI (specificity of 97.9%). A sensitivity of 93%, specificity of 100%, and positive and negative predictive values of 100% and 94%, respectively were achieved for the CT findings of visceral artery occlusion, intestinal pneumatosis, portomesenteric venous gas or bowel wall thickening in combination with either portomesenteric thrombosis or solid organ infarction. Our findings suggest that mesenteric MDCT angiography is an accurate tool for fast diagnostic work-up of patients with suspected AMI.