警惕血管栓塞性的急性腹痛(附急性肠系膜上动脉栓塞二例)

急性肠系膜上动脉栓塞是由于栓子堵塞了肠系膜上动脉引起肠缺血坏死的一种急性病变。因其发病急,进展快,误诊率高,病死率达70 %～90 % [1] ,早期诊断困难,尤应引起临床重视。我院1999年5月～2 0 0 3年5月收治急性肠系膜上动脉栓塞3例,其中2例误诊,现分析报告如下。1　病例资料【例1】　男,5 0岁。因间断上腹部胀痛伴食欲缺乏1年,加重1天入院。1年前无明显诱因出现上腹部胀痛,呈间断性,进食可诱发,按“胃炎”予抑酸、解痉及对症治疗,症状可缓解,1年来上述症状反复发作。入院前1天上腹部疼痛复发,呈持续性绞痛并向左下腹放射,伴恶心,呕吐少量…     

婴儿肠套叠腹部平片X线表现与空气灌肠整复疗效的关系

【目的】了解空气灌肠治疗前婴儿肠套叠腹部平片的X线表现,探讨不同X线表现与空气灌肠整复疗效的关系。【方法】回顾性分析526例经空气灌肠及手术确诊的婴儿肠套叠腹部平片X线表现和X线空气灌肠整复结果。【结果】526例婴儿肠套叠的腹部平片X线表现主要为腹部局限性积气、肠胀气或不完全性小肠梗阻、完全性肠梗阻,其空气灌肠复住成功率分别为82．5％、78．3％、35．2％。前两者与完全性肠梗阻患儿的空气灌肠整复成功率分别进行比较均存在显著性差异（P〈0．01）;而前二者之间进行比较无显著性差异（P〉0．05）。【结论】婴儿肠套叠的腹部平片的X线表现有一定特征,对空气灌肠整复治疗有重要的指导意义。     

一例急性肠系膜上动脉栓塞术后并发下肢动脉栓塞的护理

急性肠系膜上动脉栓塞是一种少见的急腹症,表现为腹部剧烈绞痛,早期症状不典型,易漏诊、误诊,一旦确诊应积极手术治疗。我科于2009年11月收治1例急性肠系膜上动脉栓塞术后并发下肢动脉栓塞患者,现报告如下。     

腹腔动脉闭塞的紧急外科治疗

临床上常见的血管源性急腹症,较多报道是急性肠系膜上动脉栓塞,表现为突发性、剧烈的腹痛,伴恶心、呕吐等胃肠道症状,发病早期常缺乏腹部压痛和反跳痛等腹膜炎特征.患者可同时合并房颤等器质性心脏疾患.     

小儿急性重症胰腺炎临床特征分析

【目的】探讨小儿急性重症胰腺炎的临床特征,以提高对该病的认识及诊治水平。【方法】对19例小儿急性重症胰腺炎的临床资料进行回顾性分析。【结果】小儿急性重症胰腺炎可发生于任何年龄,以学龄期儿童多见,男多于女。病因以暴饮暴食多见,起病急骤凶险。腹痛、呕吐、休克为其主要临床表现,白细胞增高,血尿淀粉酶降低,血糖增高,血清白蛋白下降及血氧饱和度降低可作为重症胰腺炎病情凶险的预兆指标。【结论】腹部B超及CT为诊断急性重症胰腺炎的有效手段之一。腹水穿刺、腹水淀粉酶检查可作为诊断之重要手段。内外科配合治疗,尤其早期行外科手术治疗是治愈的关键。     

类风湿关节炎手腕关节病变的X线片和MRI诊断价值

【目的】探讨类风湿性关节炎（RA）手腕关节病变的x线片和MRI表现及临床应用价值。【方法】回顾性分析24例RA患者双手、腕关节X线平片和MRI表现,以及临床主要实验室指标（RF、ESR、CRP及抗CCP抗体）阳性率及临床表现,将24例患者按年龄不同分为三个年龄组,各组间进行比较。【结果】所有24例RA患者在MRI上均有阳性表现：即滑膜炎、骨髓水肿、骨侵蚀及关节腔积液,有的出现两种或以上表现;只有10例RA患者在x线平片上出现阳性表现;临床实验室各项指标在不同年龄组亦有阳性表现,但与MRI表现无特异相关性。不同年龄组的MRI阳性率有一定的差别,但统计学上无明确差异（P〉0．05）。【结论]MRI可以很好地反映RA手腕关节病变的病理变化过程,对早期RA的诊断价值远远大于x线平片,MRI对不同发病时间的RA诊断、治疗随访及预后判断有很重要的价值。     

急性肠系膜动脉性缺血患者的术后护理

肠系膜动脉缺血性疾病是指由于肠系膜动脉的急性血循环障碍,导致肠管缺血坏死,临床上表现为血运性肠梗阻.其原因包括肠系膜上动脉栓塞及肠系膜上动脉血栓形成,其中以肠系膜上动脉栓塞较多见.临床起病急骤,病情发展迅速,误诊率及死亡率均较高.因此,护理干预对急性肠系膜动脉性缺血的康复非常重要.我科2008年1月～2011年6月对32例患有急性肠系膜动脉性缺血的术后患者进行护理干预,取得满意效果,现报告如下.     

急性肠系膜血管缺血性疾病八例诊治分析

目的探讨急性肠系膜血管缺血性疾病的诊断及治疗方法。方法对我院2006～2009年收治的8例急性肠系膜血管缺血性疾病的诊断及治疗经过进行回顾性分析。结果本组经腹部选择性动脉造影确诊为肠系膜上动脉血栓形成3例,肠系膜上静脉损伤修复后经超声多普勒检查诊断血栓形成1例,手术探查证实肠系膜上动脉栓塞4例。给予溶栓治疗4例,手术治疗5例(其中1例为溶栓治疗无效者)。7例痊愈,1例合并糖尿病肾病取栓术后6d死于肾衰竭。结论急性肠系膜血管缺血性疾病确诊困难,早期诊断和及时处理是治愈的关键。     

急性肠系膜动脉栓塞的诊治探讨

急性肠系膜动脉栓塞具有发病急剧、进展迅速、病情险恶、误诊率及死亡率较高的临床特点。近期我院收治２例，现结合文献对急性肠系膜动脉栓塞的诊治做初步探讨。１病例简介【例１】患者女，７８岁，以突发持续性腹痛３６小时入院。腹痛先以脐周明显，继以全腹剧痛，伴恶心...     

急性小肠坏死9O例临床分析

目的：探讨急性小肠坏死的病因及其临床特征,提高急性小肠坏死的诊治水平。方法：收集2003-01-2012—12收治的急性小肠坏死患者的一般资料、病史、临床表现、并发症、影像学检查、血液学检查、病理检查等相关资料,归纳总结其临床特征。结果：共收集急性小肠坏死病例90例,其中嵌顿疝26例、粘连24例、肠扭转22例、肠系膜上动脉栓塞9例、肠系膜上静脉血栓形成5例、腹部闭合性损伤3例、肠套叠1例。全组治愈81例,病情危重自动放弃4例,死亡5例。结论：急性小肠坏死病因复杂,早期诊断困难,及时行手术切除是一种有效的治愈方法。     

Acute intestinal ischemia due to occlusion of the superior mesenteric artery: detection with Doppler sonography.

The aim of our study was to assess the feasibility of using Doppler sonography for the detection of acute intestinal ischemia due to occlusion of the superior mesenteric artery. Between September 1993 and March 1995, abdominal sonography with Doppler imaging of the mesenteric vessels was performed in 770 patients with emergency admissions for acute abdominal pain. In six cases, the diagnosis, based on surgery or arteriography and computed tomography, was acute intestinal ischemia due to complete or localized occlusion of the superior mesenteric artery. Five cases of occlusion of the superior mesenteric artery were correctly detected by Doppler sonography. These results suggest that Doppler sonography may be a feasible method for detecting acute intestinal ischemia due to proximal superior mesenteric artery occlusion.     

急性肠系膜缺血性疾病早期CT血管成像影像特征分析

目的探讨急性肠系膜缺血性疾病（AMI）早期CT血管成像（CTA）的影像特征,为AMI的早期诊断提供参考。方法回顾性分析9例AMI患者的CTA检查资料。结果 9例中1例发现肠系膜上动脉血栓,1例发现肠系膜上动脉分支血栓,2例发现肠系膜下动脉血栓,1例发现肠系膜上静脉血栓,1例发现肠系膜上静脉分支血栓,3例发现肠系膜下静脉血栓;2例行数字减影血管造影（DSA）检查确诊肠系膜上动脉及分支血栓;9例血栓性肠坏死,治愈4例（44.44%,4/9）,死亡5例（55.56%,5/9）。结论 AMI早期诊断困难,病情发展迅速,病死率高;早期诊断CT检查诊断意义不大,CTA以及选择性肠系膜DSA检查有确诊意义;CTA在AMI的早期诊断中有重要意义。     

磁共振DWI早期呈阴性的急性缺血性脑卒中的临床特点及原因分析

[目的] 研究磁共振弥散加权成像(DWI)早期呈阴性的急性缺血性脑卒中的临床特点及原因.[方法] 回顾性分析2014年1月至2016年2月于本院神经内科住院的3例磁共振DWI早期呈阴性的急性缺血性脑卒中患者临床特点及原因.[结果] 3例患者中1例在起病7 h后行磁共振DWI未发现急性梗死灶,起病64 h后复查磁共振DWI发现延髓背外侧近期梗死;1例在起病6 h后行磁共振DWI未发现急性梗死灶,起病52 h、症状加重28 h后复查磁共振DWI发现右侧基底节区近期梗死;1例在起病5 h后行磁共振DWI未发现急性梗死灶,起病120 h后复查磁共振DWI发现延髓右下背侧近期梗死.[结论] 磁共振DWI是目前早期临床诊断急性缺血性脑卒中的有力手段,目前普遍公认急性缺血性脑卒中发病几分钟即可出现阳性表现,但急性脑缺血性脑卒中早期DWI呈阴性的患者大量存在,DWI阳性甚至可延迟到起病后120 h.当遇到怀疑急性缺血性脑卒中但DWI未见责任灶的患者时,除了尽早治疗外,必要时需再次进行磁共振DWI检查,以早期明确诊断,减少误诊及漏诊.     

Conduite à tenir devant une suspicion d’ischémie mésentérique aiguë

Acute mesenteric ischemia (AMI) is a diagnostic and therapeutic emergency medicine. Its mortality remains high (30 to 95%), depending on both its etiologies and the rapidity of treatment. The term acute mesenteric ischemia is currently applied to a wide spectrum of bowel injuries within the distribution of the superior mesenteric vessels, ranging from reversible alterations in bowel function (acute mesenteric ischemia syndrome) to transmural necrosis of the bowel wall (mesenteric infarction). AMI may result from a superior mesenteric embolus, thrombosis of the superior mesenteric artery or vein, or non-occlusive mesenteric ischemia. The lack of specific clinical signs requires other diagnostic means. Abdominal computed tomographic scan is currently the most efficient diagnostic tool. It also helps to rule out diseases that may mimic AMI. Intravenous contrast injection may show mesenteric vascular occlusion and specific abnomalities of the bowel mucosae. Initial treatment consists of volume resuscitation and administration of appropriate doses of vasopressive drugs. The vasospasm treatment needs further clinical research. Diagnostic and therapeutic angiography is not easy to perform in regular practice, whereas a selective superior mesenteric artery catheter may allow a specific treatment for some patients. A multidisciplinary approach is needed for an accurate diagnosis and treatment.     

缺血性肠病的诊治进展

缺血性肠病可分为急性肠系膜缺血(AMI)、慢性肠系膜缺血(CMI)及缺血性结肠炎(IC)。本病患者多有心血管相关的基础疾病史,有习惯性便秘或近期手术史。主要症状根据分型各有特点,AMI表现为无相应体征的剧烈上腹痛或脐周痛,合并心房颤动的器质性心脏病以及胃肠道排空障碍;CMI特点为频繁饭后腹痛、畏食及体质量下降;IC表现为左侧腹部突发性绞痛,多餐后加重,梗死坏疽后可有急性腹膜炎表现。实验室检查最多见为血白细胞增高及大便潜血实验阳性,D-二聚体升高可能对本病诊断有一定意义。腹部超声、X光、CT、MRI、肠镜、选择性血管造影在本病的诊断方面各有独特的作用。本病的诊断来源于对病因、病史、临床表现、实验室及辅助检查的综合判断。治疗分为内科治疗、介入治疗、外科手术治疗,各有其针对性及适应证。通过及时确定不同类型缺血性肠病的诊断,采取适宜的治疗方法,对改善患者的预后和降低病死率有重大意义。     

Isolated superior mesenteric artery dissection: An updated review of the literature

Isolated superior mesenteric artery dissection (ISMAD) is a rare but potentially life-threatening cause of acute abdominal pain. Owing to the availability of computed tomography angiography, more cases have been detected during screening for acute abdomen in recent years. With increasing knowledge of ISMAD, a better management strategy is being developed. To enhance our understanding and improve treatment outcomes of ISMAD, a systematic literature review was conducted with a focus on diagnosis and management strategies based on existing evidence.     

Ileal hemorrhagic infarction after carotid artery stenting: A case report and review of the literature

BACKGROUNDIleal hemorrhagic infarction after carotid artery stenting (CAS) is a fatal complication. The prognosis of ileal hemorrhagic infarction after CAS is very poor if not treated in a timely manner. We describe a rare case of ileal hemorrhagic infarction due to acute embolism of the mesenteric artery after CAS. CASE SUMMARYA 67-year-old man with acute ischemic stroke underwent CAS via the right femoral artery approach 21 d after intensive medical treatment. On the first day after surgery, the patient had abdominal distension and abdominal pain. Abdominal enhanced computed tomography revealed intestinal obstruction, severe stenosis of the superior mesenteric artery, and poor distal angiography. An exploratory laparotomy was performed, and pathological examination showed hemorrhagic ileal infarction. It was subsequently found that the patient had intestinal flatulence. With the guidance of an ultrasound scan, the patient underwent abdominal puncture, drainage, and catheterization. After 58 d of treatment, the patient was discharged from hospital with a National Institutes of Health Stroke Scale score of 2 points, and a Modified Rankin Scale score of 1 point. At the 6-mo follow-up, the patient had an excellent functional outcome without stroke or mesenteric ischemia. Furthermore, computed tomography angiography showed that the carotid stent was patent.CONCLUSIONIleal hemorrhagic infarction is a fatal complication after CAS, usually caused by mesenteric artery embolism. Thus, more attention should be paid to the complications of embolism in the vascular system as well as the nervous system after CAS, and the complications should be identified and treated as early as possible.     

急性肠系膜缺血性疾病35例的诊治体会

目的总结急性肠系膜缺血性疾病的早期诊治经验。方法回顾性分析1988～2007年间诊治的35例急性肠系膜缺血性疾病患者的临床资料。发生在肠系膜动脉30例，肠系膜静脉5例。主要临床表现为急性腹痛（94％）；51％的患者有血清酶谱异常。结果全部病例均通过手术得以证实。4例行肠系膜上动脉置管溶栓，15例行Fogarty导管取栓术，16例行肠管切除。总病死率为23％，肠管坏死病例病死率为50％，多例患者术后出现再灌注损伤。结论动态观察血清酶谱变化有助于该类疾病的早期诊断，对术后再灌注损伤要高度重视。     

Emergency Bedside Ultrasound Diagnosis of Superior Mesenteric Artery Dissection Complicating Acute Aortic Dissection

Background

A timely diagnosis of aortic dissection is associated with lower mortality. The use of emergent bedside ultrasound has been described to diagnose aortic dissection. However, there is limited literature regarding the use of bedside ultrasound to identify superior mesenteric artery dissection, a known high-risk feature of aortic dissection.

Objective

Our aim was to present a case of superior mesenteric artery dissection identified by bedside ultrasound and review the utility of bedside ultrasound in the diagnosis of aortic emergencies.

Case Report

We report a case of superior mesenteric artery dissection found on emergent bedside ultrasound in a 46-year-old male complaining of abdominal pain with a history of cocaine abuse and prior aortic dissection. Bedside ultrasound in the emergency department revealed an intimal flap in the descending aorta with extension into the superior mesenteric artery prompting early surgical consultation before computed tomography because of concern for acute mesenteric ischemia.

Conclusion

Superior mesenteric artery dissection is a high-risk feature of aortic dissection and can be identified with emergent bedside ultrasound.