肝硬化患者肠系膜上动脉血流动力学的变化与腹水形成的关系

采用彩色多普勒超声对40例健康者（对照组）及80例有（或）无腹水肝硬化患者（肝硬化组）进行肠系膜上动脉（SMA）血流动力学测定。结果显示：肝硬化患者SMA内径（D）、血流速度（v)、血流量（Q）均较对照组显著升高,有腹水者较无腹水者高、SMA脉动指数（SMA－PI）和阻力指数（SMA－RI）均显著降低（P＜0．01）,尤以SMPI降低明显。肝硬化腹水组治疗前后上述各指标均无明显差异（P＞0．05）。提示肝硬化患者SMA处于高动力循环状态,此为肝硬化腹水形成的原因之一。     

溃疡性结肠炎患者血小板功能变化的观察

目的 了解溃疡性结肠炎（ulcerative colitis，UC）患者血小板功能状态的变化及其与疾病的关系。方法对2006年住院的20例治疗前后血小板计数、平均体积（MPV）、聚集率进行分析。结果患者治疗前平均血小板计数385．61×10^12／L。治疗后192．67×10^12／L，差异无统计学意义（P〉0．05）。治疗前后血小板平均体积进行比较：治疗前9．53fl，治疗后11．58fl，两组数据有统计学意义（P〈0．01）。治疗前血小板最大聚集率0．65，治疗后0．30，两者有统计学意义（P〈0．01）。不同严重程度病人之间血小板聚集率及血小板平均体积差别具有统计学意义（P〈0．01），而未发现血小板计数与病情的关系（P〉0．05）。计算活动期、缓解期病人血小板聚集率、血小板平均体积与血小板计数三者的相关系数，并进行统计学检验，未见相关（P〉0．05）。结论 血小板功能状态的改变可能是UC肠道病变活动性的指标之一，并能反映疾病的程度。     

溃疡性结肠炎患者骨密度变化及其相关因素的研究

目的探讨溃疡性结肠炎（UC）患者骨密度（BMD）变化及其与血清中钙、磷、镁、碱性磷酸酶（ALP）、白蛋白（ALB）、肿瘤坏死因子-α（TNF-α）、血管内皮生长因子（VEGF）、白细胞介素-6（IL-6）的相关性。方法用定量CT（QCT）对入选的96例UC患者和100名健康人（对照组）进行BMD测定和相关实验室指标的检测。结果UC组50岁以上者BMD明显低于相应年龄对照组（P〈0.05）；重度UC患者血钙、磷、镁较对照组明显下降（P〈0.05）；BMD与VEGF（r=-0.425，P〈0.05）、TNF-α（r=-0.642，P〈0.05）、IL-6（r=-0.465，P〈0.05）呈负相关。结论UC患者可引起BMD降低而发生骨质疏松，与血钙、磷、镁、白蛋白等营养物质代谢紊乱、年龄、炎性细胞因子等密切有关。     

溃疡性结肠炎患者外周血BPC和MPV的变化及意义

检测56例活动期溃疡性结肠炎（UC）患者（实验组）及30例健康对照者（对照组）外周血血小板计数（BPC）和平均体积（MPV）。56例UC患者经用艾迪沙治疗后缓解37例（缓解组）,同样方法检测其外周血中的BPC和MPV。结果缓解组、实验组BPC及MPV明显高于对照组（P〈0．05,P〈0．01）,实验组明显高于缓解组（P〈0．05）;实验组不同程度UC患者BPC及MPV比较,P均〈0．05。认为活动期UC患者外周血BPC及MPV明显升高,BPC及MPV可作为评价UC活动度及其严重程度的参考指标。     

活动期溃疡性结肠炎患者血脂与蛋白质变化

[目的]观察活动期溃疡性结肠炎(UC)患者血脂与蛋白质水平,评价其与病情严重程度间的关系。[方法]对活动期UC住院患者94例与体检正常者(对照组)100例的总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)水平进行回顾并研究其与严重程度之间的关系。[结果]与对照组比较,活动期UC患者TC、TG、LDL、HDL、TP、ALB、PA水平明显降低,TC、TP、ALB水平与Baron评分呈负相关,ALB与ESR负相关。[结论]活动期UC患者易出现血脂及蛋白异常,TC、ALB可作为病情严重程度评价指标。     

溃疡性结肠炎患者内镜分析

目的 回顾性探讨昆明市近10年来溃疡性结肠炎(UC)住院患者内镜表现.方法 选取昆明市1998年1月～2009年3月期间7家大型综合医院379例住院的炎症性肠病患者作为调查对象,诊断均符合2007年中华医学会消化病学分会的UC诊治标准,分析UC患者内镜下表现.结果 有98.2％的病例接受结肠镜检查,其诊断符合率为88.4％.100％为活动期,其中轻度38.3％,中度42.2％,重度19.5％.分型如下:直肠型者13.2％,直肠和乙状结肠型26.9％,左半结肠型34.9％,右半结肠型3.2％,全结肠型21.7％.内镜下表现病变呈弥漫性分布90.50％,充血水肿86.20％,糜烂或溃疡76.90％,活动性出血60％,脓性分泌物25％,假性息肉18％.结论 昆明市UC患者的病期以中度为主,病变范围以左半结肠型和直肠和乙状结肠型为主,以弥漫性分布、充血水肿、糜烂或溃疡为主要表现.     

经肠系膜动脉导管治疗溃疡性结肠炎

目的研究经导管肠系膜动脉注射治疗溃疡性结肠炎的效果．方法１９９３／１９９７收住辽宁省人民医院消化病房的活动期溃疡性结肠炎患者１３例．患者入院后次日经股动脉插管至肠系膜上或下动脉，先行全结肠数字减影，确定病变范围及程度，然后经导管向肠系膜下或上动脉缓慢推注甲基强的松龙复合制剂．观察动注后患者的临床症状及体征改变情况．３ｄ后，加用灌肠治疗．记录治疗后１ｗｋ，１，２ｍｏ患者的症状、体征、便常规及肠镜改变情况．并长期随访患者．结果经导管冲击治疗后１ｄ～３ｄ，大部分患者的临床症状迅速改善．１ｗｋ后粘液脓血便情况基本消失．灌肠１ｍｏ～２ｍｏ后，未见复发．粪常规恢复正常．肠镜示原病变消失．随诊１ａ～４ａ，除３例因症状复发再行导管治疗外，余未见复发．结论经导管肠系膜动脉注射治疗溃疡性结肠炎，可迅速控制活动期的临床症状，改善肠粘膜病变．该疗法不仅具有局部药物浓度高，全身副作用少，药物能均匀分布受累肠段毛细血管的特点，而且数字减影可清楚显示病变范围及程度．诊断和治疗一次性完成，值得深入研究     

溃疡性结肠炎患者血清MDA及SOD的变化

目的探讨氧自由基损伤与溃疡性结肠炎(UC)发病之间的关系.方法测定UC患者(n=26)血清中丙二醛(MDA)浓度和超氧化物歧化酶(SOD)活力,并与正常对照(n=30)比较.结果正常对照,直肠乙状结肠炎(n=15)和病变超过乙状结肠者(n=11)血清中MDA浓度依次升高(分别为3.85±0.54,5.12±0.65和7.03±0.82 μmoL/L),差异均有显著性(P＜0.05,P＜0.02);而血清SOD活力依次下降(分别为113.72±10.36,82.59±11.87和58.15±10.33),差异均有显著性(P＜0.05,P＜0.01).结论氧自由基损伤是UC发病过程中的一个重要因素.SOD活力下降是氧自基基损伤的重要原因之一.     

穿孔素在溃疡性结肠炎患者肠黏膜的表达及意义

本研究利用激光扫描共聚焦显微镜技术 ,对溃疡性结肠炎 (ｕｌｃｅｒａｔｉｖｅｃｏｌｉｔｉｓ,ＵＣ)患者肠黏膜中穿孔素的表达进行检测 ,以期有助于阐明穿孔素介导的细胞毒机制是否在ＵＣ发病中起作用。材料与方法一、研究对象从 19例ＵＣ患者病变肠黏膜及 12例结肠癌患者手术标本正常肠段各取一块活检标本 ,放入液氮中速冻 2 0ｓ后取出 ,- 75°Ｃ冰箱贮存备用。二、试剂与仪器Ｐｅｒｆｏｒｉｎ 1抗体 (ＩｇＧ ,ｃ 2 0 )系山羊抗人多克隆抗体(ＳａｎｔａＣｒｕｚ公司 ,美国 )。荧光二抗系猪抗山羊ＩｇＧ抗体(Ｄａｋｏ公司 ,丹麦 )。标记的荧…     

Successful treatment of pseudoaneurysms of celiac and superior mesenteric arteries by combined endovascular and surgical approach

Pseudoaneurysm after pancreas resection poses serious complications, including rupture and hemorrhage. Here we report a case of delayed massive hemorrhage from celiac and superior mesenteric arteries, which was successfully treated with a combined endovascular and surgical approach. The patient was a 52-year-old man who presented with pseudoaneurysms of the celiac and superior mesenteric arteries after distal pancreatectomy. Following the detection of sentinel bleeding from the abdominal drain, emergency angiography of the celiac and superior mesenteric arteries revealed stenosis of the celiac artery and pseudoaneurysms in the superior mesenteric artery. We occluded these lesions with a platinum coil, using an interventional radiological technique combined with bypass grafting between the abdominal aorta and the SMA, using the saphenous vein. However, re-bleeding into the abdominal cavity occurred from the proximal SMA pseudoaneurysm. We inserted an endoluminal stent-graft into the abdominal aorta and completed bypass grafting between the aorta and bilateral renal arteries. The hemorrhage ceased and the postoperative course was uneventful. The patient was discharged 34 days after the treatment (149 days after the initial operation). In conclusion, this combined endovascular and surgical approach is feasible and seems appropriate for pseudoaneurysms arising from proximal sites in visceral arteries.     

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.     

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。     

Atherosclerotic inferior mesenteric artery stenosis resulting in large intestinal hypoperfusion: A paradigm shift in the diagnosis and management of symptomatic chronic mesenteric ischemia

Symptomatic chronic mesenteric ischemia results from intestinal hypoperfusion and is classically thought to result from involvement of two or more mesenteric arteries. The celiac artery and superior mesenteric artery are most frequently implicated in this disease process, and their involvement usually results in symptoms of small intestinal ischemia. Symptomatic chronic mesenteric ischemia resulting predominantly from inferior mesenteric artery involvement has largely been overlooked but does gives rise to its own, unique clinical presentation with symptoms resulting from large intestinal ischemia. We present four patients with atherosclerotic inferior mesenteric artery stenosis with symptomatic chronic mesenteric ischemia that have unique clinical presentations consistent with large intestinal ischemia that resolved following percutaneous endovascular treatment of the inferior mesenteric artery stenosis. These cases represent a novel approach to the diagnosis and management of this disease process and may warrant a further subclassification of chronic mesenteric ischemia into chronic small intestinal ischemia and chronic large intestinal ischemia.© 2012 Wiley Periodicals, Inc.     

Survival and causes of death in Italian patients with ulcerative colitis A GISC nation-wide study

BACKGROUND: Death rate for patients with ulcerative colitis has changed over last few decades. Recent studies indicate that cumulative long-term mortality is comparable to that in general population, and that deaths may depend on causes not strictly related to colonic disease. AIM: To evaluate overall and cause-specific mortality rate in a large group of Italian patients with ulcerative colitis. METHODS: A total of 2,066 ulcerative colitis patients aged >18 years consecutively diagnosed in twenty Italian Gastroenterology Units between 1964 and 1995 were followed-up from diagnosis until 1997. Standardised Mortality Ratios and Relative Survival Ratios were calculated. RESULTS: Overall mortality of patients with ulcerative colitis was comparable to that in general population with 93 deaths observed versus 92.1 expected (standardises mortality ratio, 1.0; 95% confidence interval, 0.8-1.2). Significantly higher mortality was observed in patients under 30 years of age at diagnosis (standardised mortality ratio, 2.7; 95% confidence interval, 1.3-4.9), and in those diagnosed before 1974 (standardised mortality ratio, 2.7; 95% confidence interval, 1.1-5.7). Proctocolitis and complications from surgery were mentioned in 11 and 5 certificates, respectively. A significant excess of deaths was observed for colorectal cancer (colon: standardised mortality ratio, 3.0; 95% confidence interval, 1.0-6.9; rectum: standardised mortality ratio, 4.4; 95% confidence interval, 1.2-11.3), and haemolymphopoietic neoplasms (standardised mortality ratio, 2.8; 95% confidence interval, 1.0-6.1), in particular multiple myeloma and non-Hodgkin lymphoma. A significant deficit of deaths was observed for cancer of the respiratory system (standardised mortality ratio, 0.3; 95% confidence interval, 0.1-1.0). CONCLUSIONS: This study confirms that, also in Italy, mortality of patients with ulcerative colitis is comparable to that in general population. Only 12% of deaths were due to ulcerative colitis itself, whereas 10% of deaths were attributed to colorectal cancer. Deaths from colorectal cancer occurred, on average, 9 years after diagnosis of ulcerative colitis, suggesting that the risk of cancer is not limited to patients with long-standing colitis. As to mortality for causes unrelated to colitis, there was an excess of deaths due to malignancies of the haemolymphopoietic system.     

Mesenteric blood flow is related to disease activity and risk of relapse in ulcerative colitis: a prospective follow up study

BACKGROUND: The diagnostic significance of increased splanchnic blood flow in ulcerative colitis is unclear. This prospective study was therefore undertaken to define the role of Doppler sonography in the assessment of disease activity and in the prediction of early relapse. SUBJECTS/METHODS: Splanchnic flowmetry was performed in 76 patients with ulcerative colitis (47 with active disease and 29 in remission), six with infectious colitis, and 13 healthy controls during fasting and 30 minutes after ingestion of a standardised meal. Twenty seven of the patients with ulcerative colitis and all patients with infectious colitis were investigated during the active state as well as in clinical remission and followed up for six months. Flow velocity and pulsatility index (PI) of the superior (SMA) and inferior (IMA) mesenteric arteries and the portal vein were related to clinical (Truelove index), laboratory (C-reactive protein), and endoscopic (Sutherland index) parameters of disease activity. RESULTS: The mean flow velocity of the IMA correlated closest with clinical activity (Truelove, r = 0.41, p<0.005), the PI with C-reactive protein (r = 0.30, p<0.05), and endoscopic activity (r = 0.45, p<0.001). All patients in remission after six months (14/14) or with infectious colitis (6/6) showed an increase in PI of the IMA compared with the initial measurement during active disease (mean increase for ulcerative colitis +36% and for infectious colitis +77%). In contrast, most patients with later relapse or surgery (11/13) had decreased PI during initial remission (mean decrease -12%). The positive predictive value of this index for maintenance of remission was 0.77. Flow variables of the SMA and portal vein displayed weaker correlations. CONCLUSIONS: Flow measurements in the IMA are closely related to clinical and endoscopic disease activity in patients with ulcerative colitis. Repeated measurement of the PI allows estimation of the risk of recurrence.     

肠系膜下动脉解剖分型在肠系膜下动脉结扎方式选择中的应用

目的探讨肠系膜下动脉（IMA）各种解剖分型及血管长度差异的相关因素,为结直肠癌低位结扎IMA提供参考。 方法前瞻性收集温州医科大学附属第一医院2019年7月至2020年4月因乙状结肠癌及直肠癌接受根治性手术治疗的患者的病例资料,术前使用增强CT对IMA进行重建,对IMA分型进行统计分析。并选取温州医科大学解剖教研室10具成人尸体,进行IMA解剖。 结果共纳入172例血管充盈可,重建效果佳的患者数据,纳入统计。按照Murono分型标准,其中Ⅰ型88例,Ⅱ型66例,Ⅲ型16例,Ⅳ型患者2例（不纳入后续统计分析）。170例患者中,IMA主干长（42.96±6.78）mm,体重是IMA主干长的主要影响因素（系数=0.253,P＜0.05）,IMA主干长度=23.12+0.253×体重（R²=0.181）。体重每增加一个单位（kg）,长度平均增加0.253个单位（mm）。 结论对IMA术前行增强CT可以了解IMA分型,有助于低位结扎位置的选择。可通过体重对IMA血管长度进行预估,从而选择最合适的血管处理方式。     

大鼠溃疡性结肠炎模型的实验研究

[目的]探讨不同剂量的5％2，4，6，三硝基苯磺酸（TNBs），所建立的急性期溃疡性结肠炎（UC）动物模型。[方法]用聚丙烯管插入大鼠肛门上段8cm后，注入不同剂量混合试剂（TNBs 50～100mg／kg加50％乙醇0．25m1），1周后处死动物，进行组织形态学评分和光镜评估。[结果]TNBs 100mg/kg剂量下引起的UC模型，肉眼见结肠黏膜多处溃疡，黏膜显著充血水肿。组织学检查发现黏膜及黏膜下层有大量中性粒细胞及淋巴细胞、巨噬细胞、纤维细胞浸润，肉芽组织及隐窝脓肿形成，50mg／kg剂量时有一较轻度的损伤。[结论]用TNBs所致的UC模型简单易行，重复性好；其溃疡炎症类似人UC的改变。实验的最佳造模剂量为100mg／kg。     

Three-dimensional studies on the structure of the tissue surrounding the superior mesenteric artery

The anatomy and topography of tissue surrounding the superior mesenteric artery were examined histopathologically, and the structure surrounding the superior mesenteric artery (SMA) was reconstructed with data from histologic examination and three-dimensional analyses. Specimens were obtained from three autopsy cases without abnormalities, two surgically resected cases of cancer of the pancreatic head, and one autopsy case of cancer of the pancreatic head. The endothelium or basal membrane of blood and lymph vessels were identified immunohistochemically, and the distribution of lymph nodes, blood vessels, lymph vessels, and collagen fibers was determined. The superior mesenteric plexus was found to be a relatively dense structure with a thickness of about 2 mm, composed of collagen fibers and connective tissue, which concentrically enveloped the small arteries, the superior mesenteric artery, nerve bundles, and capillaries. Lymph vessels larger than a few micrometers in diameter were often found outside of the plexus, and this plexus contained no lymph nodes in any sections. The three-dimensional study of the modes of spread along the superior mesenteric artery of pancreatic cancer revealed two types of spread: the tumor extends mainly by neural invasion, and the tumor extends mainly by lymph node metastases. These morphologic features suggest that lymphatic flow in the vicinity of the superior mesenteric artery passes primarily outside of the plexus, and complete excision of lymph nodes close to the superior mesenteric artery with preservation of the superior mesenteric plexus is feasible if there is no neural invasion into retropancreatic tissues.