X线检查诊断十二指肠壅滞症72例临床分析

目的探讨十二指肠壅滞症X线特点，提高对该病的诊断水平。方法回顾性分析72例十二指肠壅滞症的临床表现和X线特征。结果本病的主要临床表现为餐后上腹部饱胀、反酸嗳气、恶心、呕吐等。X线钡餐造影显示十二指肠水平段钡剂通过受阻，十二指肠扩张，出现典型“笔杆样”压迹，右侧位或俯卧位时症状可缓解。结论X线钡餐造影足十二指肠壅滞症简单、叮靠的诊断手段，可减少本病的误诊与漏诊。     

腹腔动脉压迫综合征

腹腔动脉压迫综合征(celiac artery compression syndrome,CACS)是指中弓韧带或膈肌脚以及神经组织等压迫腹腔动脉,从而引起餐后腹痛、呼气相增强的上腹部杂音、影像上腹腔动脉狭窄＞75％的一组症候群,是慢性肠系膜缺血的病因之一.CACS也称中弓韧带综合征或Dunbar综合征,其不同于肠系膜上动脉综合征(superior mesenteric artery syndrome,SMAS),SMAS是肠系膜上动脉压迫十二指肠水平段导致的近端肠梗阻的病因之一.1917年Lipshutz[1]第1次描述了腹腔动脉被外来结构如中弓韧带压迫的现象.     

急性肠系膜上动脉缺血临床诊治研究进展

急性肠系膜缺血多见于肠系膜上动脉(superior mesenteric artery,SMA),急性肠系膜上动脉缺血(acute superior mesentericartery ischemia,ASMAI)是由于肠系膜上动脉供血障碍导致缺血,进而引起肠壁坏死的综合征。ASMAI起病急骤,病情发展迅速,症状与体征常不相符,加之临床医生对其缺乏足够认识,因此误诊、漏诊和病死率较高。本病常见于中老年人,且男性多于女性。本文对ASMAI的病因与分类、临床表现、辅助检查、诊断及治疗进行综述,为临床诊治提供理论依据。     

经PEJ肠内营养在肠系膜上动脉压迫综合征治疗中的作用

目的:观察经皮内镜下胃造口空肠置管术(PEJ)行EN支持在肠系膜上动脉压迫综合征治疗中的作用.方法:对2例肠系膜上动脉压迫综合征病人行PEJ,采用EN支持分别治疗69 d和180 d.观察病人症状改善、体质量和营养指标的变化.结果:2例病人经EN支持,症状消失,体质量增加,血中纤维连接蛋白和PA增加.结论:经PEJ行EN支持是治疗肠系膜上动脉压迫综合征的有效方法之一.     

肠系膜上动脉综合征：附6例治疗体会

肠系膜上动脉综合征,又称十二指肠血管压迫综合征或 Wilkie 氐病。因肠系膜上动脉压迫十二指肠水平部而引起的梗阻,导致十二指肠近段郁滞、扩张等一系列症状。现将我院收治6例总结如下。临床资料本组6例临床资料见附表。     

16排螺旋CT增强扫描及CT血管成像对肠系膜上动脉压迫综合征的诊断价值

目的探讨16排螺旋CT增强扫描及CT血管成像（CTA）对肠系膜上动脉压迫综合征的诊断价值。方法回顾性分析经CT血管成像诊断肠系膜上动脉压迫综合征26例的16排螺旋CT资料。使用16排螺旋CT行腹部三期增强扫描。在工作站采用多平面重组（MPR）、最大密度投影（MIP）重组肠系膜上动脉图像。分析16排螺旋CT血管成像对肠系膜上动脉压迫综合征的诊断价值。结果 26例患者均清晰显示肠系膜上动脉（SMA）、十二指肠、腹主动脉（AA）三者的解剖关系。SMA走行为径直型的22例占85%,SMA与AA间的夹角6°～25°的21例占81%,SMA与AA间的距离为3.5～5.0 mm的20例占77%,有十二指肠壅积征象;SMA走行为转折型的有4例,占16%.结论 16排螺旋CT增强扫描及肠系膜上动脉血管成像可以明确观察肠系膜上动脉走行及与周围组织结构的关系,对肠系膜上动脉压迫综合征的临床诊断具有重要的参考价值。     

肠系膜上动脉综合征几种术式的选择与评价

肠系膜上动脉综合征(Superior Mesenteric Artery Syndrome)因肠系膜上动脉压迫十二指肠水平部而引起梗阻,导致十二指肠近段郁滞、扩张,在临床上出现上腹部胀满、腹痛、恶心呕吐等一系列症状,故称为肠系膜上动脉综合征。为解决十二指肠梗阻,恢复肠道通畅,往往需要外科手术治疗,现就不同的术式讨论如下:     

十二指肠淤滞症的X线造影诊断及相关探讨

目的:探讨十二指肠淤滞症的X线表现及结合文献复习其相关知识.方法:分析医院收治的22例十二指肠淤滞症患者,18例行钡餐造影,4例行碘水造影.结果:22例患者影像学表现典型,均为肠系膜上动脉压迫所致,已明确诊断.结论:X线造影检查可作为十二指肠淤滞症诊断的依据.     

肠系膜上动脉综合征的外科治疗

肠系膜上动脉综合征 (ｓｕｐｅｒｉｏｒｍｅｓｅｎｔｅｒｉｃａｒｔｅｒｙｓｙｎｄｒｏｍｅ ,ＳＭＡＳ)临床上并不罕见。 1974年Ａｋｉｎ[1] 命名为十二指肠血管性压迫综合征 ,又称肠系膜上动脉压迫综合征、慢性十二指肠部分或完全性梗阻。1　病因1 1　先天性解剖病理变异因素　 ( 1)肠系膜上动脉与腹主动脉的夹角较小 :当立位或仰卧位时 ,肠系膜上动脉就将十二指肠横部和升部压迫于椎体、椎旁肌或腹主动脉上 ,造成肠腔狭窄和梗阻 ;( 2 )Ｔｒｅｉｔｚ韧带过短 :十二指肠空肠悬韧带过短悬吊固定位置过高者 ,致十二指肠横部居于肠系膜上动脉与…     

急性肠系膜上动脉闭塞性疾病诊治体会

目的 总结急性肠系膜上动脉闭塞性疾病的临床表现、诊断和治疗方法,提高对该病的认识.方法 回顾性分析2005年11月至2007年4月收治的7例急性肠系膜上动脉闭塞性疾病患者的诊断和治疗过程.结果 5例患者采取手术治疗,术后4例存活,1例因感染性休克而死亡;1例患者采取保守治疗好转;1例患者采用介入治疗后痊愈.结论 提高对急性肠系膜上动脉闭塞性疾病的认识,掌握该病的临床表现和检查手段,可以减少漏诊和误诊,提高患者的生存率.     

64排螺旋CT血管成像诊断肠系膜上动脉病变

目的探讨64排螺旋CT血管成像在临床诊断肠系膜上动脉病变及肠系膜上动脉相关病变的价值。方法以31例初步诊断为疑似肠系膜上动脉病变或肠系膜上动脉相关病变的患者作为研究对象。对所有患者行全腹部多层螺旋CT容积扫描。待获取扫描原始数据后,采用图像后处理技术进行图像的后处理,包括：三维最大密度投影（3DMIP）、多平面重组（MPR）、容积再现（VR）。并对扫描结果进行分析。结果所有患者经多螺旋CT血管成像均可使肠系膜上动脉及其分支清晰显示。其中,肠系膜上动脉压迫综合症12例,包括＂胡桃夹＂综合征7例和十二指肠淤滞症5例;肠系膜上动脉夹层3例,包括孤立性肠系膜上动脉夹层1例和胸腹主动脉夹层累及肠系膜主动脉2例;肠系膜上动脉缺血性病变15例。结论 64排多螺旋CT血管成像可清晰观察到肠系膜上动脉及其周围血管的各种病变情况,对肠系膜上动脉病变及肠系膜上动脉相关病变的诊断具有重要价值,值得在临床肠系膜上动脉病变的诊断中推广应用。     

彩色多普勒超声分析2型糖尿病患者颈动脉与研究肠系膜上动脉病变的相关性

目的运用彩色多普勒超声分析2型糖尿病患者的颈动脉和肠系膜上动脉的血流动力学信息,比较两支动脉血管血流动力学指标的相关性,探讨糖尿病对血管粥样硬化的影响。方法选择2型糖尿病患者127例定义为糖尿病组,运用彩色多普勒超声进行颈动脉及肠系膜上动脉检查,记录两支血管的搏动指数(PI)、阻力指数(RI),并分析两者的相关性。结果 127例2型糖尿病患者中,68.5%的患者颈动脉提示动脉粥样硬化;57.4%的患者肠系膜上动脉提示动脉粥样硬化。颈动脉提示粥样硬化的2型糖尿病患者中,73.6%的患者肠系膜上动脉也提示动脉粥样硬化。糖尿病组颈动脉和肠系膜上动脉的PI和RI均明显小于对照组(P﹤0.05)。糖尿病组颈总动脉和肠系膜上动脉的PI和RI线性相关(P﹤0.01)。结论 2型糖尿病患者的颈动脉与肠系膜上动脉的粥样硬化发病率呈正相关。证明糖尿病诱发血管粥样硬化是全身性的,颈动脉粥样硬化程度越严重,肠系膜上动脉粥样硬化发病率越高。     

Superior mesenteric artery aneurysm in a patient with chronic abdominal pain

Superior mesenteric artery (SMA) aneurysm is a rare disease. In this case report, we present a 32 years old woman who was admitted to our hospital with chronic abdominal pain. SMA aneurysm was diagnosed after radiological evaluation. The patient underwent ligation of the superior mesenteric artery aneurysm and remained well 12 months after the surgery.     

Functional duodenal obstruction (superior mesenteric artery or cast syndrome) in cerebral palsy

An 8-yr-old girl with cerebral palsy who was chronically malnourished presented with functional duodenal obstruction (superior mesenteric artery or cast syndrome) proven by barium meal. Six months of feeding through a fluoroscopically positioned gastrojejunal tube generated sufficient weight gain and increase in body bulk to cure the functional obstruction.     

Vomiting, abdominal pain and weight loss with an acquired anatomical cause: superior mesenteric artery syndrome

Superior mesenteric artery syndrome (SMAS) is a rare and acquired anatomical condition characterized by vomiting, abdominal distension, weight loss and postprandial distress due to compression of the transverse portion of the duodenum between the superior mesenteric artery (SMA) and aorta, which causes duodenal outflow problems. We report a case series of three patients with SMAS. Diagnosis of the syndrome was made by augmenting a high degree of suspicion with repeat gastroscopies, CT scans and hypotonic duodenal contrast series showing compression of the horizontal part of the duodenum located between the vessels specified above. Medical therapy for the condition is aimed at nutritional rehabilitation so that weight gain results in relief of the obstruction. In each of our patients, surgical treatment was necessary during which the ligament of Treitz was divided and a side-to-side duodenojejunostomy was performed. In all, the weight loss seen preoperatively has been corrected.     

Anorexia in a 14-Year-Old Girl: Why Won’t She Eat?

This is a clinical presentation of a 14-year-old female who had weight loss and vomiting following spinal fusion surgery. Her case was complicated by social and behavioral issues. After an initial diagnosis of atypical eating disorder, an upper gastrointestinal study revealed superior mesenteric artery syndrome. Her course continued to be complicated until consistent follow-up with a nutritionist was established.     

Gastrointestinal surgery and gastroenterology. VIII. Gastroenterologic aspects of chronic gastrointestinal ischemia

The main cause of chronic gastrointestinal ischaemia is atherosclerosis. Stenotic lesions of the mesenteric circulation are relatively common, but lead to chronic ischaemic complaints due to collateral circulation in probably only 2-3 per 100,000 inhabitants per year. The classical presentation (post-prandial abdominal pain, weight loss, upper abdominal souffle) is present in a minority of patients only. Symptoms also occur after exercise. Gastric ulcers and diarrhoea are less frequent. Although patients with 2 and 3 vessel involvement (coeliac artery, superior mesenteric artery and inferior mesenteric artery) usually experience the most severe ischemic complaints, patients with single vessel involvement can also develop symptoms. In the diagnosis of cases with abdominal complaints, factors that aggravate or reduce the complaints anamnestically are the guideline for supplementary diagnostics. The more frequent causes of the symptoms are to be excluded first. Doppler-ultrasonography of the mesenteric vessels can detect most stenotic lesions accurately. To establish the diagnosis visceral angiography is needed. A new method of examination is magnetic resonance angiography (MRA). Another new method is tonometry during exercise: a PCO2 value in the lumen that is higher than that in the blood indicates ischaemia. Non-invasive treatment of chronic gastrointestinal ischaemia is aimed at reduction of the gastrointestinal metabolic workload by smaller meals, at suppression of acid secretion, at inhibition of the secretion of gastric acid and on risk factors for atherosclerosis.     

急性肠系膜血管闭塞的诊治分析

目的 总结急性肠系膜血管闭塞（AMVO）的诊断与治疗。方法 对1989年5月-2005年5月收治的11例AMVO患者的诊治资料进行回顾性分析。肠系膜上动脉栓塞（MAE）5例，肠系膜上动脉血栓形成（MAT）3例，肠系膜上静脉血栓形成（MVT）2例，非阻塞性肠系膜血管供血不全（NOMI）1例。10例手术，其中坏死肠管切除一期吻合6例，二期吻合3例，1例保守治疗。所有病例均经抗凝、祛聚、扩血管治疗。结果 11例患者最终治愈6例，死亡5例，其中2例死于中毒性休克及多器官功能衰竭，2例死于再发梗死，1例死于短肠综合征，病死率为45．5％。结论 AMVO发病急，进展快，早期易误诊，后期病情凶险，早发现、早治疗及选择合理治疗方案是保证疗效的关键。