彩色多普勒超声检查诊断肠系膜上动脉狭窄的价值

目的 探讨彩色多普勒超声检查在评估肠系膜上动脉(SMA)狭窄中的价值.方法 应用彩色多普勒超声检查对腹痛患者SMA进行检查,观察SMA起始段管腔有无斑块、血栓、隔膜样结构等引起的狭窄,测量SMA狭窄患者(SMA狭窄组)SMA狭窄处血流速度和腹主动脉血流速度,并观察SMA狭窄远端的血流频谱.以30例无腹痛患者为对照组,彩色多普勒超声测量对照组SMA起始段血流速度和腹主动脉血流速度.结果 3360例腹痛患者中彩色多普勒超声检出SMA狭窄患者15例,其中SMA起始段粥样硬化斑块10例,风湿性心脏病血栓栓塞1例,主动脉夹层导致SMA壁内血肿2例,肌纤维发育不良引起环形缩窄2例.全部病例均经CT血管造影及临床最终证实.所有SMA狭窄组患者SMA狭窄处血流速度均大于275 cm/s,狭窄率大于70%,狭窄处远端血流频谱呈典型的"小慢波".SMA狭窄组患者SMA狭窄处血流速度最高为493 cm/s,最低为291 cm/s,平均为(351.44±58.91)cm/s.对照组SMA起始段血流速度平均为(148.47±32.47)cm/s.SMA狭窄组患者SMA狭窄处血流速度明显高于对照组SMA起始段血流速度,差异有统计学意义(t=14.96,P<0.0001).SMA狭窄组患者SMA狭窄处血流速度/腹主动脉血流速度比值均＞3,对照组SMA起始段血流速度/腹主动脉血流速度比值均<3.结论 彩色多普勒超声检查对SMA狭窄诊断价值较高,能够准确显示SMA狭窄的部位、狭窄程度和血流动力学的改变,对腹痛患者的病因筛查有重要的临床意义.

The value of color Doppler flow imaging in diagnosis of superior mesenteric artery stenosis

Objective To explore the value of color Doppler flow imaging(CDFI)in diagnosis of superior mesenteric artery(SMA)stenosis.Methods The patients with abdominal pain were examined by CDFI to evalutate the initial segment of SMA with focus on the observations of plaques,thrombus,septum-like structure.And the systolic peak velocity (PSV) at stenosis was measured and the distal post-stenotic Doppler spectrum was detected.Thirty out-patients without abdominal pain were as control group,the PSV of SMA initial segment and aorta were measured.Results Fifteen cases with SMA stenosis were detected by sonography in 3360 out-patients with abdominal pain,due to atherosclerotic plaque in 10,thromboembolism by rheumatic heart disease in 1,intramural hematoma by aortic dissection in 2,fibromuscular dysplasia 2.All cases were confirmed by CT angiography(CTA).The PSV in all cases exceeded 275 cm/s indicating the stenosis rate beyond 70%.In addition,the distal post-stenotic Doppler spectrum showed the"tardus-parvus"pattern.The maximum and minimum PSV at stenosis was 493 cm/s and 291 cm/s respectively with an average of (351.44±58.91)cm/s.In patients without SAM stenosis,the PSV of SMA initial segment was (148.47±32.47)cm/s,which was significantly lower than that in stenotic patients(t=14.96,P<0.0001).In addition, the PSV ratio of SAM and aorta was all higher than 3 in stenosis group, while was all lower than 3 in non-stenosis group.Conclusions CDFI is of great value in diagnosis of SMA stenosis,which could accurately display the location and degree of stenosis and the hemodynamic changes.Therefore CDFI plays an important role in etiological screening for patients with abdominal pain.