急性肠系膜上动脉栓塞的临床诊疗体会

目的探讨急性肠系膜上动脉栓塞的诊断和治疗。方法对收治的急性肠系膜上动脉栓塞11例的临床资料进行回顾性分析。结果11例中8例术前分别经CTA三维重建或肠系膜上动脉造影确诊,3例经剖腹探查确诊。6例行坏死肠段切除吻合术,3例死亡。5例行肠系膜上动脉切开取栓加坏死肠段切除吻合术,死亡2例。总死亡率45.5%。死亡原因主要为感染性休克和多脏器功能衰竭。结论对于急腹症患者,临床不能明确诊断时,应警惕肠系膜上动脉栓塞的可能。 CTA和肠系膜上动脉造影是诊断急性肠系膜上动脉栓塞的有效手段,早期明确诊断手术是提高治愈率的关键。     

冠心病合并一过性缺血性结肠炎一例报道

正缺血性肠病是一组由多种病因及危险因素造成血液供应匮乏或回流受限导致肠壁出现不同程度病变及损害的肠道相关疾病,一般分为急、慢性肠系膜缺血以及缺血性结肠炎,且以结肠缺血为主[1]。它可能是全身动脉粥样硬化的一种表现。近来有指南提出用结肠缺血这一术语代替缺血性结肠炎更为合适[2]。结肠缺血是最常见的肠道     

肠系膜上动脉狭窄、闭塞和压迫综合征的彩色多普勒超声诊断和临床意义

肠系膜上动脉狭窄,闭塞或受压迫而引起的疾病是一组以小肠供血不足为特征的急慢性缺血性病变。我们自1997年6月至2001年5月应用彩色多普勒检测肠系膜上动脉病变23例,全部经临床确诊或手术后病理检查符合诊断。 1 资料与方法 1.1 临床资料:23例患者均为因腹部症状临床上需彩超协助检查者,年龄在3岁至85岁,其中男性8例、女性15例。本病由于受累的血管缺血程度不同而临床表现不同,慢性肠系膜上动脉狭窄和肠系膜上动脉压迫综合征可以无明显症状或仅餐后饱胀、腹痛;急性肠系膜上动脉闭塞可致肠管广泛性坏死、便血、肠穿孔、急性腹膜炎、代谢性酸中毒、休克甚至死亡。 1.2 检查方法:使用ATL超9HDI型、东芝6000     

肠系膜淋巴管瘤的临床、影像及病理学特征

目的：探讨肠系膜淋巴管瘤的临床表现、影像学特点及病理学特征。方法收集14例肠系膜淋巴管瘤患者的临床资料,回顾性分析其临床病理特征及影像学表现。结果14例肠系膜淋巴管瘤临床症状多样化,以腹部胀痛不适多见。术前影像学检查：2例CT示淋巴管瘤,5例仅提示囊性占位,2例诊断为其他肿瘤,3例肠梗阻或肠扭转或肠套叠,2例未见明显病变。病变主体多位于肠系膜并累及肠壁,镜下呈多房囊腔,内衬单层扁平细胞,管腔内可见淋巴液及淋巴细胞。免疫组化标记瘤细胞均表达D2-40。结论肠系膜淋巴管瘤属良性肿瘤,应警惕并发症,术前影像学检查可提示诊断,明确诊断依赖病理学检查。     

老年性缺血性肠炎的影像诊断

目的 分析老年性缺血性肠炎的影像学表现,探讨老年性缺血性肠炎的影像学诊断价值.方法 对照综合分析本院近年来经临床、手术病理证实的9例老年性缺血性肠炎的X线、CT和DSA的影像资料和病理结果.结果 9例老年性缺血性肠炎者X线立位、卧位撮片,均见腹部肠腔扩张,积气、积液,8例CT均显示肠腔广泛扩张,积气、积液,并见节段性肠壁增厚、粘膜下水肿呈靶征,4 例可见大量腹水.4例行肠系膜动脉CTA多平面重组(MPR),显示局部肠系膜动脉分支狭窄变细;2例行DSA示肠系膜上、下动脉纤细、远端分支显示不清.5例行手术治疗,术中见局部肠管呈暗红或暗黑色,粘膜广泛糜烂、坏死.组织病理片示肠系膜小动脉内膜纤维性增厚,血管壁间质纤维化;4例经保守支持治疗,2周后症状缓解出院.结论 对老年人不明原因的肠梗阻要考虑肠系膜血管缺血的可能,应及时作CT检查以明确诊断.     

儿童股骨头缺血性坏死

儿童股骨头缺血性坏死又称Perthes病、儿童股骨头无菌性坏死,目前认为它是一种自限性疾病,但病因未明。所谓自限性或自愈性,是指股骨头的坏死最终可自然修复而痊愈。但其后遗的股骨头畸形,可导致髋关节负重和活动功能的障碍,甚至致残致畸。此病治疗的目的在于减轻临床症状,改善髋关节功能,预防病变的进行性加重,使股骨头能获得良好的包容,获得生物学塑型而恢复原有的形状。儿童股骨头缺血性坏死的治疗方法众多,但疗效均尚未令人满意;其中既有针对病因（尤其是改善缺血）而设计的治疗方案,又有针对病理演变规律,防止股骨头畸形而设计的治疗方案,使人难以选择。本文介绍了近年儿童股骨头缺血性坏死的研究进展。     

中国成人自身免疫性肠病的临床特点分析

目的通过分析中国成人自身免疫性肠病(AIE)的临床特点,提高对该疾病的认识和早期诊断水平。方法回顾性分析北京协和医院2011年至2018年收治的5例成人自身免疫性肠病患者的临床表现、影像学及内镜检查结果、病理特点及治疗随访情况。结果 5例AIE患者中男1例,女4例,平均年龄42岁;中位病程2个月,中位住院日期56 d;均以顽固性大量水样泻为首发症状,多伴有电解质紊乱、严重营养不良和炎性指标轻度升高;有2例出现低血容量性休克、2例并发Wernicke脑病。腹盆CT检查示非特异性肠道病变,可表现为肠壁增厚、肠黏膜强化、肠腔积液积气、腹膜后及肠系膜周围多发淋巴结形态饱满或轻度增大。内镜下病变轻微,可见黏膜充血肿胀、粗糙不平、点状糜烂灶。病理表现典型,包括小肠绒毛短缩、上皮内杯状细胞、潘氏细胞减少、隐窝凋亡小体增多、黏膜固有层炎细胞浸润、上皮内淋巴细胞增多。结论成人AIE的临床表现和辅助检查缺乏特异性。内镜下可仅有轻微病变,对疑诊AIE的患者应积极行内镜活检,尤其是十二指肠部位的活检,以明确诊断。     

椎管内髓外硬膜下室管膜瘤1例并文献复习

目的探讨椎管内髓外硬膜下(intradural extramedullary, IDEM)室管膜瘤的临床病理特征、诊断及鉴别诊断。方法分析1例儿童多节段病变IDEM室管膜瘤的临床、病理及影像学资料,并复习相关文献。结果患儿女,8岁,颈段、胸段多发髓外占位性病变。镜下见肿瘤细胞呈假菊形团状排列,局部坏死,核分裂活跃。肿瘤细胞GFAP呈阳性,EMA呈灶阳性。肿瘤部分节段完整切除。结论发生于IDEM的室管膜瘤临床少见,尤其是儿童多节段病变IDEM室管膜瘤临床罕见。由于其特殊的发病部位,应根据临床、影像学特点、病理特征进行综合诊断。     

布加综合征根治术术式选择及手术要点

目的：探讨Budd-Chairi综合征四种根治术的适应证、优缺点及术中注意事项。方法：患总数143例，其中单纯隔膜切除36例，下腔静脉病变段切开、心包片成形45例，下腔静脉病变段切除、人工血管原位移植50例，肝静脉主干闭塞段及其上方的下腔静脉闭塞段切除、肝静脉流出道扩大成形、肝静脉开口至下腔静脉的右房人口处人工血管原位移植术12例。术中出血均采用人工心肺机自血回输。结果：无手术死亡。住院期间4例死于并发症(2例心衰，1例胸腔大出血，1例肝昏迷)。出院时除2例无效以外，均效果良好。随访107例，时间6-108个月，平均50个月，复发6例，其中肝静脉流出道成形术1例，心包片成形术4例，下腔静脉病变段切除、人工血管原位移植术1例。结论：四种根治术有各自不同的适应证，单纯隔膜切除术和下腔静脉病段切除、人工血管原位移植术的远期通畅率高于另二种根治术。术中梗阻远端出血的控制最为重要。     

使用静脉留置针致小儿皮肤局灶性坏死1例

静脉留置针在临床的使用意义很大，虽有有关静脉留置针导致静脉炎和静脉留置针套管折断的个案报道，但对留置针致液体外渗致皮肤局灶性坏死却较少见。现将使用静脉留置针致小儿皮肤局灶性坏死1例报告如下。     

Enterocolic lymphocytic phlebitis: clinicopathologic features and review of the literature

Enterocolic lymphocytic phlebitis (ELP) is a recently described entity and is of unknown etiology and pathogenesis. It is characterized by phlebitis of the bowel wall and mesentery, without arterial involvement or evidence of systemic vasculitis. The clinical presentation of ELP is varied, but it most commonly manifests with signs of an acute abdomen. Clinical, radiologic, and endoscopic findings are often conflicting and misdiagnosis is common as venous thrombosis is not suspected. The diagnosis of ELP is obtained histologically. There is a spectrum of histologic features associated with ELP, which includes lymphocytic phlebitis, necrotizing phlebitis, granulomatous phlebitis, and myointimal hyperplasia. Other features include venous thrombi and acute ischemic changes of the intestine. Surgical resection of the affected bowel is usually curative and recurrences are rare. The clinical and histopathologic features of ELP are reviewed.     

“Enterocolic phlebitis” mimicking a primary tumor of the cecum – A rare presentation of an unusual entity

Intestinal vasculitis is an infrequent entity in the absence of systemic vasculitis or chronic inflammatory bowel disease. The primary involvement of gut restricted to mesenteric venous territory is exceedingly rare. We report a pseudotumoural lesion of the cecum caused by localized phlebitis and venulitis associated with thrombosis, with a putative immune etiology, in a young adult presenting with obstructive intestinal crisis.     

Intestinal Buerger's disease

We describe a 50-year-old man who, at 26 years of age, underwent a hemicolectomy on the right side of the abdomen due to infarction of the right colon. At 35 years of age, a stenotic, ischemic segment of distal jejunum was resected. Later he had had intermittent claudication, migratory thrombophlebitis, and recurrent cerebral infarctions. The mesenteric and mural blood vessels of both resected specimens of bowel showed an occlusive process with organized and recent thrombi and marked transmural inflammation. The internal elastic lamina and media in the arteries were preserved and there was no evidence of atheroma or calcification. The histologic findings were consistent with thromboangiitis obliterans. We suggest that the same mechanism may be responsible for intestinal peripheral and cerebrovascular involvement.     

Mesenteric venous thrombosis due to antithrombin III deficiency

A 19-year-old woman developed gradually worsening abdominal pain, signs of peritonitis, and hematemesis. Laparotomy revealed peritonitis due to segmental small-bowel infarction, and the underlying pathologic condition was mesenteric vein thrombosis. A primary thrombotic disorder was suggested and antithrombin III deficiency was found. Before anticoagulant therapy could be initiated, she developed hemorrhagic cerebral infarction and died. Her history included three episodes of deep vein thrombosis while taking oral contraceptives. Her father died of spontaneous mesenteric and portal vein thrombosis at age 29 years. This report underlines the importance of careful interpretation of the vascular pathology in cases of intestinal ischemia.     

Ischemic stenosis of the ileum with reactive parietal and lymph-nodal angioendotheliomatous hyperplasia

Ischemic stenosis of ileum with reactive parietal and lymph node angioendotheliomatous hyperplasia. The case subject of this study represents a form of segmentary chronic ischemic enteritis with intramural haematoma, intestinal stenosis and neighbouring mesenteric venous thrombosis. In the histopathologic picture it is of great interest a peculiar lesion of the intestinal wall which has been interpreted like reactive nodular angioendotheliomatous hyperplasia, associated to diffuse parietal granulation tissue formation and marked transmural neoangiogenesis. This lesion also interests a small locoregional mesenteric lymph node, where it appears to be included in a morphological picture of nodal angiomatosis (also known as vascular transformation of lymph node sinus). The last pathological entity has been thought to take rise from a local perinodal venous obstruction. This aetiopathogenetic interpretation has been also referred to the lesion of the intestinal wall which for the Author's knowledge is not accompanied by similar examples in the literature. The patient is a 28 years old man who after a six years follow up presents perfect health.     

Idiopathic enterocolic lymphocytic phlebitis: a rare cause of ischemic colitis.

We report on a 74-year-old female patient who was admitted to the hospital because of abdominal pain. She underwent a colonoscopy and a stenosing mass was found in the cecum. Histologic findings in the biopsy specimens were consistent with ischemic colitis. Due to clinical symptoms and the endoscopic and radiologic findings that roused the suspicion that the patient was suffering from a malignant tumor, a right hemicolectomy was performed. Histology of the resection specimen disclosed an inflammation of the veins. It was characterized by a predominantly lymphocytic infiltration of the vessels affecting the veins of the colonic wall and the mesentery. Furthermore, secondary thrombosis with focal venous occlusion was observed. The colon showed extensive ischemic colitis with focal transmural coagulation necrosis. The disease was considered to be idiopathic lymphocytic phlebitis, which is a rare disease of unknown origin. Our patient is well and alive after more than 1 year, supporting the notion that the disease shows a benign course after surgery.     

Hepatic portal venous gas: A case report and review of literature

Hepatic portal venous gas (HPVG) results from mesenteric ischemia and a wide variety of other causes. The primary factors that favour the development of this pathologic entity are intestinal wall alterations, bowel distension, and sepsis. Findings of HPVG during an ultrasound or computed tomography (CT) scan should be carefully evaluated in the context of the clinical picture. In the absence of features of bowel ischemia, the prognosis of patients with HPVG is usually good.     

Mesenteric venous thrombosis and antithrombin III deficiency.

Of the 123 patients with acute mesenteric infarction treated over the past 12 years, 16 (13%) had mesenteric venous thrombosis. Eight of the patients with mesenteric venous thrombosis survived the initial episode; two have since died. The remaining six patients were studied for evidence of haemostatic deficiencies or abnormalities. Antithrombin III deficiency, which is known to be associated with recurrent venous thrombosis, was found in three patients. It is recommended that all patients with mesenteric venous thrombosis should be screened for antithrombin III deficiency as treatment with coumarin anticoagulants may be indicated, providing effective prophylaxis against further thrombotic episodes.     

Primary granulomatous giant cell polyphlebitis of visceral veins

A case of granulomatous giant cell phlebitis occurred in the mesenteric veins of a 38-year-old man, resulting in segmental infarction of the ileum. Multiple epitheloid granulomas with giant cells of the Langhans type were situated in media/adventitia of small and middle-sized mesenteric veins with subsequent thrombotic venous occlusions. No involvement of arterial vessels could be detected. The aetiology of the disease remains unknown. Known types of vasculitis were excluded. It was assumed that this is an example of in immunological vasculopathy but this could not be proved.     

Mechanical complications of myocardial infarction

Acute myocardial infarction is responsible for a significant proportion of morbidity and mortality in patients with ischaemic heart disease. Apart from cardiogenic shock, important mechanical complications include myocardial rupture, mitral regurgitation, mural thrombosis, left ventricular true aneurysm and pericarditis. Such patients are likely to be older (more than 60 years of age), especially women with hypertension, single-vessel disease, first episode of transmural infarction, smaller area of infarction, and/or delayed thrombolytic therapy. The incidences of all these complications have significantly reduced due to availability of reperfusion techniques. Myocardial rupture includes rupture of the left ventricular free wall, interventricular septum or papillary muscles, which can occur within few hours or days after infarction and emergency surgery is indicated. Lateral displacement of papillary muscles due to post-infarctional left ventricular remodelling is the main factor for ischaemic mitral regurgitation; some patients would require mitral valve repair or replacement. Mural thrombosis results from an abnormal flow and local hypercoagulable state and requires thrombolytic therapy or even surgical excision. Post-infarctional fibrosis is also responsible for formation of ventricular apical aneurysms and depending on the clinical status, reconstructional surgery may be required. Dressler's syndrome is a rare occurrence of fibrinous pericarditis accompanied by constitutional symptoms, which responds to immunomodulation.