弹簧圈栓塞肠系膜上动脉分支治疗小肠出血的体会

目的探讨肠系膜上动脉分支栓塞治疗小肠出血的临床疗效及并发症。方法选取2004年7月-2011年11月在巴彦淖尔市医院行选择性肠系膜上动脉造影,证实为小肠出血的患者11例,根据出血血管选择不同的弹簧圈置入。置入后再次造影观察栓塞效果。结果 11例患者全部一次栓塞肠系膜上动脉分支成功,成功率100%。术后给予补液、止血及对症治疗。结论肠系膜上动脉分支栓塞是治疗不能手术的小肠出血的有效方法,是小肠大出血及反复不明原因小肠出血的首选治疗措施。     

AngioJet Ultra血栓清除系统在肠系膜上动脉栓塞中的应用二例

<正>1临床资料病例一患者男性,66岁。因腹痛8 h于2014年12月9日入院。入院前8 h患者田间劳作时突感腹痛,位于中上腹部,性质不清,程度重,不向他处放射,伴出汗、心悸、气短,蜷缩位可稍减轻,无呕吐、腹泻,无明显胸痛,无黑矇、晕厥,症状持续约2 h不缓解。就诊于当地医院,诊断为急性心肌梗死,具体不详。给予阿司匹林300 mg,氯吡格雷300 mg,阿托伐他汀钙80 mg及哌替啶针100 mg肌肉注射后     

Angiojet血栓抽吸系统在急性肠系膜上动脉栓塞治疗中的应用

目的探讨Angiojet血栓抽吸系统对急性肠系膜上动脉栓塞的治疗效果。方法回顾我院用Angiojet血栓抽吸系统对3例急性肠系膜上动脉栓塞患者的治疗经验,结合文献对急性肠系膜上动脉栓塞的诊断、治疗进行综合分析。结果收治的3例急性肠系膜上动脉栓塞患者中,2例有心房颤动病史,1例为肠系膜上动脉夹层;采用Angiojet血栓抽吸系统早期清除血栓后再联合导管溶栓等治疗,均取得满意疗效。结论急性肠系膜上动脉栓塞起病急促,早期诊断尤为重要,肠系膜上动脉造影有助于早期诊断,Angiojet血栓抽吸系统能够早期清除血栓,恢复血供,对急性肠系膜上动脉栓塞具有良好的效果。     

肠系膜上动脉栓塞的临床特征分析

[目的]探讨肠系膜上动脉栓塞(superior mesenteric artery embolism, SMAE)的临床特征。[方法]纳入诊断为SAME患者42例,根据治疗结果分为好转组与死亡组,对其临床资料进行统计学分析。[结果]42例患者平均年龄为(65.8±13.7)岁,男27例(64.3%)女15例(35.7%),伴有高血压22例、动脉硬化16例、心房颤动17例、动脉栓塞史14例、糖尿病9例、腹部手术史8例。所有患者均为急性腹痛起病,伴有恶心呕吐27例、便血17例。中性粒细胞百分比升高32例、白细胞升高27例、C-反应蛋白升高29例、凝血酶原时间延长32例、活化部分凝血酶原时间延长17例、纤维蛋白原升高22例、D-二聚体升高23例。血管CT确诊的36例患者均发现肠系膜上动脉管腔充盈缺损,腹腔积液21例、肠管增厚积气14例、肠坏死11例,肠梗阻3例。死亡组平均年龄为(74.5±9.8)岁,显著高于好转组的(62.8±13.7)岁,2组比较P<0.05。死亡组患有心脏疾病、多处动脉栓塞人数明显多于好转组(P<0.05)。死亡组患高血压、糖尿病、心房颤动例数多于好转组,伴...     

2例老年肠系膜上动脉栓塞的报告

急性肠系膜上动脉栓塞（superior mesenteric artery embolism,SAME）是指栓子进入肠系膜上动脉,发生急性完全性血管闭塞,导致小肠急性缺血、功能障碍、坏死,约占急性肠系膜血管缺血性疾病的50％,年发病率约为816／10万。其发病急骤,病情凶险,致残率及死亡率极高,有文献报道,病死率可高达68％～100％,     

急性肠系膜上动脉栓塞46例诊治体会

［摘要］　目的　探讨急性肠系膜上动脉栓塞（acute superior mesenteric artery embolism,ASMAE）早期诊断及早期治疗要点,避免误诊,降低致残及致死率。方法　对2004-01～2011-01该院收治的46例ASMAE患者的临床资料进行回顾性分析。结果　病程1 h～10 d,46例均经上腹CT及腹部计算机断层X线血管造影(CTA)检查确诊为ASMAE。手术切除肠管28例,经皮介入肠系膜上动脉置管溶栓10例,肠系膜上动脉切开取栓血管再成型8例。围手术期死亡5例,短肠综合征8例,随访3年死亡,其余33例随访3年,恢复良好。结论　如出现突发剧烈腹痛和不典型的腹部体征,应警惕是ASMAE,尽早行腹部CTA检查,早期确诊、早期治疗是降低致残及致死率的关键。     

肠系膜上动脉栓塞1例报告

肠系膜动脉栓塞是一种临床少见、病情极危重的急腹症。既往文献报道即使经过积极的溶栓及手术治疗，本病的病死率仍高达30％～100％不等。近期我们收治1例肠系膜上动脉栓塞病人，临床表现不典型，行血管造影明确诊断，经对症及溶栓治疗痊愈。现报道如下。     

慢性肺源性心脏病合并肠系膜上动脉栓塞一例

肠系膜上动脉栓塞是指栓子进入肠系膜上动脉,发生急性完全性血管闭塞。肠系膜上动脉栓塞可使肠系膜上动脉血液供应突然消失,导致肠管缺血,坏死,功能障碍[1]。临床表现:发病迅速,腹痛为突然发生,并且疼痛剧烈,伴有恶心呕吐。早期时疼痛症状和体征不相符合:腹痛剧烈而腹部体征较少出现[2]。当患者出现排出红色血便或者呕吐血性胃内容时,腹痛症状可能减轻,但腹膜刺激征象可能引出如:腹部压痛、反跳痛、腹肌紧张等,肠鸣音减弱或消失。叩诊检查有移动性浊音时,腹部穿刺可抽出不凝血性液体,提示肠管坏死。随病程     

急性肠系膜上动脉及下动脉栓塞合并急性脾梗死1例

<正>急性肠系膜缺血(acute mesenteric ischemia, AMI)疾病起病突然、病情危重且变化迅速,其中急性肠系膜动脉栓塞(EAMI)往往继发于心房颤动、心脏瓣膜疾病血栓形成。早期诊断及干预是影响其预后的重要因素。但临床上早期诊断困难,肠管坏死多见,治疗缺乏统一标准,预后极差。本文分析报道急性肠系膜上动脉及下动脉栓塞合并急性脾梗死,后经急诊静脉溶栓、介入取栓及导管内溶栓、抗凝等综合治愈出院1例,为EAMI的临床诊治提供参考。     

游离肠系膜上动脉对提高胰腺钩突癌切除彻底性的临床意义

目的 观察游离肠系膜上动脉、切除肠系膜根部的扩大胰十二指肠切除术对累及肠系膜根部胰腺钩突癌的手术效果.方法 2004年1月至2007年12月为23例(男14例,女9例,年龄30～72岁)累及肠系膜根部的胰腺钩突癌患者施行了合并游离肠系膜上动脉、切除肠系膜根部的扩大胰十二指肠切除术,对手术方法 、手术安全性及手术疗效进行分析.结果 12例患者施行了肠系膜根部切除的扩大胰十二指肠切除术,11例同时施行了肠系膜上静脉的切除和重建.平均手术时间(4.2±1.1)h,术中出血量(1 635±1 362)ml,术中输血量(1 609±1 462)ml.全组患者无手术死亡,6例出现轻至重度腹泻,术后住院天数9～30 d.病理示,肿瘤直径3～8 cm,合并淋巴结转移13例(57%),神经浸润20例(87%),22例手术切缘均为阴性,11例血管切除患者中有10例血管内膜浸润.随访5～42个月,4例发生肝转移,3例局部复发,1年、2年的累积生存率分别为77.2%和42.5%.结论 通过游离肠系膜上动脉,对肠系膜根部组织、肠系膜上动脉周围神经以及广泛后腹膜组织的切除可以提高胰十二指肠切除术治疗胰腺钩突癌的手术彻底性,有效降低肿瘤残留,减少局部复发.手术方法 是安全的.     

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。     

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。     

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.     

肠系膜上动脉置管溶栓联合全身抗凝治疗急性广泛门静脉血栓2例报告

<正>急性门静脉血栓形成(acute portal vein thrombosis,APVT)是一种少见且临床表现复杂的急腹症,约占肠道血管性疾病的5%~15%[1]。急性广泛门静脉血栓形成(acute extensive portal vein thrombosis,AEPVT)是指门静脉、脾静脉、肠系膜上静脉、肠系膜下静脉中有2条或2条以上血管急性血栓形成[2],在临床更为罕见,治疗上也更为棘手。本文报道2例肠系膜上     

Ultrasound imaging in diagnosis of superior mesenteric artery syndrome

OBJECTIVES: We screened a cohort of subjects affected by various degree of dyspepsia to reveal if they presented a reduction of the aorto-mesenteric angle and to diagnose suspected cases of superior mesenteric artery (SMA) syndrome. DESIGN: Controlled, prospective, study. SETTING: Subjects were studied as outpatients. SUBJECTS: The study investigated a total of 3622 subjects referred to our department by their general practitioners for dyspepsia and/or abdominal pain. Interventions. Abdominal ultrasonography with power colour Doppler, gastroduodenoscopy, hypotonic duodenography, contrast-enhanced spiral computerized tomography were performed. MAIN OUTCOME MEASUREMENT AND RESULTS: Color Doppler revealed a significant reduction of the SMA angle in 29 of 950 subjects; gastroscopy showed duodenal compressive pulsation in 14 of 29 patients and X-ray revealed compression of the third segment of the duodenum in 28 of 29 patients. CT confirmed the presence of a reduced angle and various degrees of duodenal compression in all patients. Ultrasonography and CT examinations gave overlapping results (P > 0.05) in diagnosing pathological aorto-mesenteric angle. CONCLUSION: The authors believe that the incidence of reduced aorto-mesenteric angle and SMA syndrome might be underrated. Ultrasound power colour Doppler imaging is useful in epidemiological screening of reduced aorto-mesenteric angle to diagnose suspected cases of SMA syndrome.     

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。     

合并慢性左心衰竭的老年冠心病患者经桡动脉介入治疗的临床评估

目的 探讨经桡动脉介入治疗老年冠心病合并慢性左心衰竭患者的临床疗效和安全性. 方法 120例老年冠心病合并慢性左心衰患者,根据介入治疗术式的不同分为经桡动脉治疗组64例,经股动脉治疗组56例;回顾性分析X线曝光时间,术后卧床时间及并发症发生率等. 结果 桡动脉组穿刺并介入治疗成功者60例,共成功扩张病变75处,其中前降支38处,回旋支19处,右冠状动脉18处,行支架置入73枚.股动脉组手术穿刺并介入治疗成功者54例,共成功扩张病变63处,其中前降支36处,回旋支12处,右冠状动脉15处,共行支架置人61枚.两组介入治疗情况及病变程度差异无统计学意义.桡动脉组较股动脉组穿刺至置管时间延长,平均卧床时间缩短,卧床期间急性左心衰发生率减少(均P＜0.01);桡动脉组穿刺并发症、下肢深静脉血栓发生率、体循环和肺栓塞发生率均较股动脉组减少(均P＜0.05).股动脉组腰背疼痛、排尿困难、腹胀发生率明显高于桡动脉组(P＜0.05). 结论 经桡动脉介入治疗老年冠心病合并慢性左心衰竭安全性高,相比经股动脉径路占有诸多优势.     

肝动脉起源于肠系膜上动脉的改良Appleby手术1例报告

1病例资料患者女性,60岁,因“体检发现胰腺占位3 d”于2018年6月18日入本院。入院后查肿瘤指标:CA19-9403.90 U/ml;增强CT提示:胰腺尾部萎缩,体部见结节影,大小约19 mm×28 mm,考虑胰腺癌,侵犯腹腔干(celiac axis,CA)、脾动脉可能(图1)。     

Initial transcatheter thrombolysis for acute superior mesenteric venous thrombosis

AIM:To determine the optimal initial treatment modality for acute superior mesenteric vein thrombosis(ASMVT)in patients with circumscribed peritonitis.METHODS:A retrospective review was made of the Vascular Surgery Department’s medical records to identify adult patients(≥18 years old)presenting with circumscribed peritonitis and diagnosed with ASMVT by imaging or endoscopic examination.Patients were selected from the time period between October 2009and October 2012 to assess the overall performance of a new first-line treatment policy implemented in May2011 for patients with circumscribed peritonitis,which recommends transcatheter thrombolysis with local anticoagulation and endovascular mechanical thrombectomy.Of the 25 patients selected for study inclusion,12 had undergone emergency surgical exploration(group 1)and 13 had undergone the initial catheterdirected thrombolysis(group 2).Data extracted from each patient’s records for statistical analyses included method of diagnosis,symptoms,etiology and risk factors,thrombus location,initial management,morbidity,mortality,duration and total cost of hospitalization(in Renminbi,RMB),secondary operation,total length of bowel resection,duration of and findings in follow-up,and death/survival.RESULTS:The two treatment groups showed similar rates of morbidity,30-d mortality,and 1-year survival,as well as similar demographic characteristics,etiology or risk factors,computed tomography characteristics,symptoms,findings of blood testing at admission,complications,secondary operations,and follow-up outcomes.In contrast,the patients who received the initial non-operative treatment of transcatheter thrombolysis had significantly shorter durations of admission to symptom elimination(group 1:18.25±7.69 d vs group 2:7.23±2.42 d)and hospital stay(43.00±13.77 d vs 20.46±6.59 d),and early enteral or oral nutrition restoration(20.50±5.13 d vs 8.92±1.89 d),as well as significantly less total length of bowel resection(170.83±61.27 cm vs 29.23±50.24 cm)and lower total cost(200020.4±91505.62 RMB vs 72785.6±21828.16 RMB)(P<0.05 for all).Statistical analyses suggested that initial transcatheter thrombolysis is correlated with quicker resolution of the thrombus,earlier improvement of symptoms,stimulation of collateral vessel development,reversal of intestinal ischemia,receipt of localizing bowel resection to prevent short bowel syndrome,shorter hospitalization,and lower overall cost of treatment.CONCLUSION:For ASMVT patients with circumscribed peritonitis,early diagnosis is key to survival,and nonoperative transcatheter thrombolysis is feasible and effective as an initial treatment.