孤立性肠系膜上动脉夹层MSCTA诊断及转归

目的分析孤立性肠系膜上动脉夹层(ISMAD)多层螺旋CT血管造影(MSCTA)表现及转归。方法采用熊江的新ISMAD影像学分型方法,回顾性总结14例孤立性肠系膜上动脉夹层的CT资料。结果 14例患者中,Ⅰ型5例,Ⅱ型1例,Ⅲa型6例,Ⅳ型1例,Ⅴ型1例。保守治疗后随访复查4例,1例Ⅰ型真腔变通畅,1例Ⅰ型无变化,1例Ⅲa型假腔溃疡囊袋状扩大,1例Ⅲa型假腔范围扩大伴真腔进一步受压变窄。结论熊江的新影像学分型法对MSCTA诊断孤立性肠系膜上动脉夹层准确快捷有效,有利于评估孤立性肠系膜上动脉夹层动态变化和转归。     

41例孤立性肠系膜上动脉夹层的治疗经验

目的:总结孤立性肠系膜上动脉夹层(ISMAD)的治疗经验。方法:回顾性分析2010年1月至2019年5月期间南京医科大学附属常州第二人民医院和南京市高淳人民医院收治的41例ISMAD患者的临床及随访资料,并对相关数据进行分析总结。结果:41例ISMAD患者中,32例(78.0%)患者成功进行内科保守治疗,6例患者予急诊支架置入治疗,2例患者内科保守治疗失败后给予支架置入治疗,1例患者内科保守治疗失败后给予球囊扩张治疗。随访(25.1±17.2)个月,32例内科保守治疗的患者中,25例(78.1%)患者的肠系膜上动脉(SMA)完全重塑形,另外7例患者SMA部分重塑形,25例(78.1%)患者完全重塑形的发生时间均在确诊后的12~24个月;8例支架置入治疗的患者中,7例夹层动脉瘤消失,1例夹层动脉瘤仍有残留;7例支架通畅,另外1例支架近端存在一定程度的再狭窄,但无支架闭塞。结论:绝大多数ISMAD可以经内科保守治疗,SMA完全重塑形发生于确诊后的2年内;部分内科保守治疗失败的患者可以置入自膨式裸支架治疗,但存在支架再狭窄的风险。     

孤立性肠系膜上动脉夹层的诊断与治疗(附3例报告)

孤立性肠系膜上动脉夹层是一种临床罕见的疾病,自1947年Bauertield首次报道该病以来,国内外仅报道百余例。随着人民生活水平的提高,健康意识的加强及医疗技术的发展,近几年来诊断该病的患者数量有上升趋势。我院自2008年以来,共收治孤立性肠系膜上动脉夹层患者3例,现通过对患者临床症状,体征及影像学检查进行回顾性研究,旨在达到尽早明确诊断、减少误诊、对患者进行有效治疗的目的。     

自发性孤立性肠系膜上动脉夹层的诊断和非手术治疗

目的:探讨自发性孤立性肠系膜上动脉夹层(SISMAD)的诊断和非手术治疗。方法:回顾性分析2008-02-2012-01收治的13例SISMAD患者的临床资料。结果:根据Sakamoto影像学分型,Ⅰ型夹层2例,Ⅱ型6例,Ⅲ型4例,Ⅳ型1例;11例保守治疗效果良好,已随访3～46个月(平均27.3个月),无明显腹部症状复发;CTA随访(8例)结果显示,SMA夹层稳定或不同程度改善,假腔内血栓减少,夹层远端动脉开放。2例保守治疗无效后改行腔内支架植入术,其中1例用弹簧圈栓塞假腔,已分别随访7个月和19个月,无腹部症状复发。结论:CT增强或CTA对于SISMAD的诊断具有重要帮助。保守治疗SISMAD有效,一旦无效或病情进展,根据病情改行腔内治疗或手术治疗。     

支架植入治疗肠系膜上动脉合并腹腔干重度狭窄1例

1 病例资料 患者,男性,57岁,因“气短、腹痛、消瘦3个月”入院.既往有“原发性高血压（高血压）3级？、2型糖尿病”病史.吸烟30余年,20支/d.入院查体：体温36.5℃,脉搏110次/min,呼吸24次/min,血压160/105 mm Hg（1 mm Hg=0.133 kPa）;神清,精神疲倦;体型消瘦;颈静脉充盈;桶状胸,双肺呼吸音粗,双肺底可闻及湿性哕音;心界左下扩大,心率110次/min,律齐,心音低钝,心尖区可闻及2/6级收缩期吹风样杂音;舟状腹,剑突下压痛,无反跳痛,肝脾肋下未及,脐周无血管杂音;双下肢无浮肿.     

CTA诊断自发性孤立性肠系膜上动脉夹层分型及评估临床症状的价值

背景 CT血管成像(CTangiography,CTA)技术无创、快速,能准确检查、评估病变血管和管腔狭窄程度、范围等,已常规应用于自发性孤立性肠系膜上动脉夹层(spontaneous isolated superior mesenteric artery dissection,SISMAD)早期筛查.本研究进一步探究C TA诊断SISMAD分型及评估临床症状的价值.目的探究CTA诊断SISMAD分型及评估临床症状的价值.方法选取2019-10/2022-01我院95例疑似SISMAD患者,均行CTA检查,以临床结果[数字减影血管造影(digital subtraction angiography,DSA)或手术结果]作为“金标准”,分析CTA诊断SISMAD的价值,比较有临床症状、无临床症状SISMAD患者的CTA测量参数,分析CTA测量参数与SISMAD患者临床症状的相关性,采用Kappa检验CTA诊断SISMAD分型与临床结果的一致性.结果C TA诊断SISMAD的曲线下面积为0.953(95%C I:0.889-0.986),诊断敏感度、特异度分别为90.63%、100.00%...     

原发性孤立肠系膜上动脉夹层多排螺旋CT血管造影18例影像学表现

目的：分析原发性孤立肠系膜上动脉夹层（spontaneous isolated superior mesenteric artery dissection,SISMAD）多排螺旋CT（Multislicespiral Computed Tomography,MSCT）血管造影的影像学表现。方法：回顾性分析2009年10月至2012年10月间,18例SISMAD的MSCT血管造影的影像资料。分析SISMAD形态特征,包括夹层位置、管腔的扩张,血栓的存在与否,并根据Ichiro Sakamoto的标准进行分型。结果：夹层距肠系膜上动脉（SMA）开口的平均距离约为为（2.74±1.21）cm;管腔增宽6例（33%）,合并血栓存在11例（61%）。18例患者中Ⅰ型5例、Ⅱ型4例、Ⅲ型3例及Ⅳ型6例。结论：MSCT血管造影能提供SISMAD的详细影像信息,是诊断SISMAD首选检查手段。     

自发性孤立性肠系膜上动脉夹层1例并文献复习

<正>病例:患者男性,51岁,因"腹痛3 h,呕血1 h"于2013-12-24至松滋市人民医院消化内科就诊。患者3 h前进食后出现上腹部、脐周持续性隐痛,阵发性加重。1 h前出现恶心,间断性呕吐3次,初为非咖啡样胃内容物,后两次为咖啡样胃内容物,约10 m L,呕吐后仍感腹痛,无便血、黑便、头晕、心悸、尿量减少等表现,遂收入院治疗。患者既往体健,     

肠系膜上动脉压迫症1例

患者男性,48岁,因“间断腹胀、恶心、呕吐,伴消瘦3个月”入院。患者3个月前无诱因出现腹胀、恶心、呕吐。呕吐物为胃内容物,呕吐后或进食后膝胸卧位或左侧卧位时可缓解,有口苦感,多出现在餐后4~5h。发作时自己偶可扪及上腹部包块,可自行消失。大便5~6d1次,干结。无腹痛、腹泻及便血。3月来体重下降13kg。查体:体型偏瘦,无力型。皮肤、黏膜、淋巴结无异常。头、颈、胸、心、肺无异常。上腹部剑突下有压痛,叩鼓音,移动性浊音(-),肠鸣音正常,无血管杂音,无气过水音。辅助检查:血、尿、便常规及心电图、血尿淀粉酶无异常。肿瘤标记物:CEA、AF…     

慢性肠系膜动脉阻塞性疾病

肠系膜动脉包括腹腔动脉（celiac artery, CA）、肠系膜上动脉（superior mesenteric artery, SMA）、肠系膜下动脉（inferior mesenteric artery, IMA）。慢性肠系膜动脉阻塞以高龄患者多见,女性占60%,70%有吸烟病史。尸检发现,＞60岁患者CA狭窄发生率为50%、SMA为30%、IMA为20％。     

Management of isolated superior mesenteric artery dissection

AIM:To evaluate our experience of the clinical management of spontaneous isolated superior mesenteric artery dissection(ISMAD).METHODS:From January 2008 to July 2013,18 patients with ISMAD were retrospectively analyzed,including 7 patients who received conservative therapy,9patients who received reconstruction with bare stents,and 2 patients who underwent surgical treatment.The decision to intervene was based on anatomic suitability,patient comorbidities and symptoms.RESULTS:Intestinal ischemia-related symptoms completely resolved in 7 patients who received conservative therapy.Stent placement was successful in 9patients.Of the 9 patients who received endovascular stenting,abdominal pain was alleviated after the procedure and gradually disappeared within 3 d.Followup computed tomography and computed tomography angiography were available in all patients during the first month and the first year after the procedure,which revealed patent stent and patent involved superior mesenteric artery branches with complete obliteration of the dissection lesion.In the 2 patients who underwent surgical treatment,good clinical efficacy was also observed.CONCLUSION:ISMAD may be managed successfully in a variety of ways based on the clinical symptoms.ISMAD should be treated by conservative management as the first-line option,however,in those with bowel necrosis or imminent arterial rupture during conservative therapy,endovascular or surgical therapy is indicated.     

Percutaneous endovascular treatment for isolated spontaneous superior mesenteric artery dissection: Report of two cases and literature review

Isolated spontaneous superior mesenteric artery (SMA) dissection is a rare and sporadically reported condition. Therapeutic options include medical treatment, surgery, and endovascular treatment. However, the optimal treatment strategy has still not been established. We herein present two patients with acute abdomen due to isolated spontaneous SMA dissection, in whom symptoms remained despite initial anticoagulation therapy. Percutaneous endovascular treatment with stenting of the dissected main trunk to achieve complete coverage of the entry site and balloon angioplasty for the distally involved side branches were performed successfully and resulted in complete resolution of the symptoms. According to our experience and previous case reports, early (within 1 week) elective percutaneous endovascular intervention with background anticoagulation therapy is a feasible and effective treatment strategy for symptomatic patients with isolated SMA dissection. © 2009 Wiley‐Liss, Inc.     

肠系膜上动脉瘤合并梗阻性黄疸1例报道并文献复习

肠系膜上动脉瘤压迫导致梗阻性黄疸的病例非常罕见,治疗方式以手术为主。现报道我院收治的1例患者的治疗经过,供临床参考。     

Assessment of duodenal circular drainage in treatment of superior mesenteric artery syndrome

AIM： To assess the clinical value of duodenal circular drainage for superior mesenteric artery syndrome （SMAS）.
METHODS： Forty-seven cases of SMAS were treated with duodenal circular drainage from 1959 to 2001. Clinical data were analyzed retrospectively. RESULTS： In this group, good effects were achieved in 39 cases treated with duodenal circular drainage after 2-15 years of follow-up. The other eight cases were first treated with anterior repositioning of the duodenum （two cases）, duodenojejunostomy （five cases）, subtotal gastrectomy and billroth I gastrojejunostomy （one case）, but vomiting was not relieved until duodenal circular drainage was performed again. A follow-up study of 8-10 years revealed satisfactory results in these eight patients.
CONCLUSION： In SMAS, if the reversed peristalsis is strong and continuous, and vomiting occurs frequently, the symptom can not be relieved even if the obstruction of duodenum is removed surgically. The key treatment is the relief of reversed peristalsis. The duodenal circular drainage can resolve the drainage direction of duodenal content, thus relieving the symptom of vomiting.     

Successful recanalization of acute superior mesenteric artery thrombotic occlusion with primary aspiration thrombectomy

Prompt revascularization of the superior mesenteric artery(SMA) thrombotic occlusion can prevent intestinal infarction and decrease necrosis of the bowel segment.Herein,we describe two cases who underwent successful endovascular recanalization for acute SMA thrombosis using a primary aspiration thrombectomy because of possible consequent laparotomy for survey of bowel viability.The two patients had dramatic pain reliefimmediately after the procedure and remained symptomfree during the follow-up period.     

Devascularization of the superior mesenteric vein without reconstruction during surgery for retroperitoneal liposarcoma: A case report and review of literature

A 61-year-old female patient with chronic hepatitis B virus infection was diagnosed with liposarcoma in a community hospital. Fine needle aspiration biopsy confirmed the diagnosis of well-differentiated liposarcoma. Abdominal computed tomographic angiography(CTA) showed that the mass adhered to and constricted the main trunk and branch of the superior mesenteric vein(SMV), especially the ileocolic vein, and collateral circulation was observed during the vascular reconstruction scan. The abdominal liposarcoma was resected. Because of the collateral circulation, devascularization of the SMV was attempted, and we resected the eroded SMV. The condition of the blood vessels was evaluated 20 d after surgery using CTA, which showed that the SMV had disappeared. Significant improvements in SMV collateral circulation and the inferior mesenteric vein were observed after vascular reconstruction. The patient had an uneventful postoperative course except for transient gastroplegia. Twenty months after surgery, the patient had a recurrence of liposarcoma. She underwent tumor resection to remove the distal small intestine and right hemicolon. We learned that(1) direct devascularization of the main SMV trunkwithout a vein graft is possible. The presence of collateralcirculation can increase the success rate of patientsundergoing radical surgery and prevent the occurrence ofserious postoperative complications. In addition,(2) thiscase demonstrated the clinical value of 3 D reconstruction.