急性肠系膜血管缺血的诊断与治疗(附54例报告)

目的 总结急性肠系膜血管缺血的诊断和治疗经验,分析损伤控制性手术的应用价值.方法 搜集54例急性肠系膜血管缺血患者.根据术前肠系膜血管的CTA检查和术中探查情况,采取全身抗凝、血管支架、插管溶栓等序贯治疗方案,出现急性腹膜炎作为手术探查的适应证.结果 本组6例患者放弃治疗,9例全身抗凝治疗后病情好转,6例血管腔内支架治疗后治愈或好转,13例通过肠系膜上动脉行插管溶栓治疗.20例接受手术治疗的患者中9例采用了损伤控制外科方法(包括术中尽量缩短手术时间,肠管远近端外置,补片暂时性关腹等),11例常规手术治疗.本组总死亡率18.5%(10/54),手术死亡率20%(4/20),手术并发症发生率为45%(9/20),损伤控制外科组和常规治疗组死亡率分别为1/9和3/11(P>0.05),其并发症发生率分别为3/9和10/11(P<0.05).结论 CTA可作为大多数病例确诊的首选检查和诊断依据,序贯性治疗可降低本病的死亡率,而损伤控制性手术可有效减少其手术并发症.     

血管内治疗肠系膜缺血28年的经验

正摘要目的报道慢性肠系膜缺血(CMI)病人血管内治疗的结果。方法回顾性复习自1981年4月-2009年9月间在一家机构接受血管内治疗病人的资料。评价操作细节、治疗的肠系膜动脉、技术与临床的成功率、每例病人与每支血管的治疗结果。结果28年166例在治疗中使用了不同球囊与内支     

急性肠系膜缺血诊治的有关进展

本文简要介绍了急性肠系膜缺血（AMI）病理分裂、诊断和治疗的有关进展。     

急性肠系膜血管栓塞的螺旋CT诊断价值

目的：探讨急性肠系膜血管栓塞的螺旋CT诊断价值。方法搜集急性肠系膜血管栓塞病例20例,男12例,女8例,平均年龄64.2岁,7例手术病理证实外,其余13例内科保守治疗后,血管内充盈缺损消失。所有病例均行CT平扫及增强检查。结果20例中肠系膜上动脉栓塞12例,肠系膜上静脉栓塞7例,肠系膜下静脉栓塞1例。直接征象为血管内充盈缺损（20例）。间接征象为肠壁增厚（12例）、肠壁薄纸样改变（5例）、缆绳征（4例）、肠壁积气（3例）、门脉积气（2例）、肠系膜密度混浊（6例）、肠腔扩张积液（8例）及腹腔积液（9例）。结论螺旋CT是诊断急性肠系膜血管栓塞的一种快速、准确、无创检查方法,螺旋CT血管造影可显示良好的肠系膜血管图像,螺旋CT能给临床提供有价值的信息。     

孤立性肠系膜上动脉夹层血管腔内治疗

目的 探讨孤立性肠系膜上动脉夹层（ISMAD）的DSA表现以及腔内治疗的疗效.方法 4例ISMAD患者,入院后48～96h经过保守治疗后腹痛症状缓解不明显,行肠系膜上动脉造影,后行血管腔内裸支架植入.结果 肠系膜上动脉造影显示肠系膜上动脉真腔变细小,部分对比剂通过破口进入假腔.4例患者共植入6枚裸支架,支架植入后造影显示破口封堵成功,支架腔内血流通畅,假腔消失.术后腹痛症状不同程度缓解,3天后腹痛均消失.结论 DSA是诊断ISMAD可靠的方法;腔内裸支架植入术治疗ISMAD安全、有效.     

急性肠系膜缺血的CT诊断

急性肠系膜缺血(acute mesenteric ischemia，AMI)发病率随着年龄增加而增加，死亡率高达60％～90％，是一种极为凶险的外科急腹症。如何及时诊断，为手术或介入治疗创造机会，是提高患者生存率的关键。随着CT技术的发展，CT诊断AMI的价值越来越受到关注，笔者就AMI的CT诊断作一综述。     

慢性肠系膜缺血的影像学诊断及介入治疗

慢性肠系膜缺血(chronic mesenteric ischemia,CMI)又称“腹绞痛”或“肠绞痛”,在临床上较为少见,约占肠系膜缺血性疾病的5%,由于长期以来对本病认识不足,使诊治延误,常导致严重的并发症及较高病死率[1]。传统的治疗方法以外科手术为主,主要是血管转流术及动脉内膜剥脱术等,但     

急性肠系膜缺血的MSCT诊断

目的:探讨MSCT对急性肠系膜缺血的诊断价值.方法:回顾性分析经手术或介入治疗证实的36例急性肠系膜缺血患者的CT表现.所有患者均行CT检查,包括平扫、增强扫描动脉期、增强扫描门脉期并进行血管重建.后处理采用容积显示技术(VRT)、多平面重组(MPR)和薄层最大密度投影(MIP)进行动脉和门脉成像.结果:肠系膜上动脉栓...     

急性肠系膜血管闭塞诊治情况分析

目的 分析急性肠系膜血管闭塞(AMVO)的临床表现、诊断和治疗。方法 对解放军总医院20例及文献报道多家医院的92例AMVO患者,共112例进行综合分析。结果 AMVO临床表现中腹痛、腹胀、恶心呕吐、肠鸣音减弱或消失、白细胞升高等出现频率较高,既往史中多有心血管疾病、门静脉系统血流淤滞或血液高凝状态等。全组平均误诊率为61．5％,其中本院20例误诊率为45．0％。全组平均死亡率为41．9％,其中本院20例死亡率为30．0％。结论 急性肠系膜血管闭塞早期临床表现缺乏特异性,误诊率及死亡率高。对于可疑病例,应尽早行血管造影以明确诊断,提高疗效。     

DSA诊断小肠血管畸形的价值

目的探讨DSA诊断小肠血管畸形的价值。方法本文分析8例小肠血管畸形患者的临床及DSA特征,其中男性6例,女性2例,所有患者均行肠系膜上、下动脉造影。结果临床特征①急性消化道出血为主要症状;②常规检查一般为阴性;③血红蛋白含量短期内降至4～6g/ml。DSA特征①动静脉瘘;②局部肠壁染色增浓;③局部血管异常增多,结构紊乱。结论DSA是诊断血管畸形所致小肠出血的最有效的方法。     

Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy

Non-occlusive mesenteric ischemia (NOMI) compromises all forms of mesenteric ischemia with patent mesenteric arteries. It generally affects patients over 50 years of age suffering from myocardial infarction, congestive heart failure, aortic insufficiency, renal or hepatic disease and patients following cardiac surgery. Non-occlusive disease accounts for 20-30% of all cases of acute mesenteric ischemia with a mortality rate of the order of 50%. Acute abdominal pain may be the only early presenting symptom of mesenteric ischemia. Non-invasive imaging modalities, such as CT, MRI, and ultrasound, are able to evaluate the aorta and the origins of splanchnic arteries. Despite the technical evolution of those methods, selective angiography of mesenteric arteries is still the gold standard in diagnosing peripheral splanchnic vessel disease. In early non-occlusive mesenteric ischemia, as opposed to occlusive disease, there is no surgical therapy. It is known that mesenteric vasospasm persists even after correction of the precipitating event. Vasospasm frequently responds to direct intra-arterial vasodilator therapy, which is the only treatment that has been shown to be effective.     

Multidetector CT angiography in the evaluation of acute mesenteric ischemia

The aim of this study was to determine the accuracy of multidetector row CT angiography in the diagnosis of acute mesenteric ischemia. Ninety-three consecutive studies on 91 patients with clinically suspected acute mesenteric ischemia underwent abdominal CT angiography as the first, and usually the sole, diagnostic procedure. CT was performed with a multidetector 16-row CT system from the level of the diaphragm to the pelvis in two phases: early arterial and late portal phase. CT examinations were reviewed by the duty radiologist. Final diagnosis was established by a senior radiologist. CTA was diagnostic in 92 studies. Mesenteric ischemia was diagnosed in 18 patients, 14 of them were of the thromboembolic type and four from the nonocclusive type. Positive CTA findings were confirmed by surgery in 13 patients and by clinical follow-up in three cases. Other reasons for abdominal pain were diagnosed by CT in 38 patients out of the remaining 74. There were two false positive and two false negative CT results, resulting in an overall accuracy of 95.6%. Multidetector CT angiography is a fast and accurate investigation for the diagnosis of acute mesenteric ischemia and in most cases can be used as the sole diagnostic procedure.     

Multidetector CT and CT angiography in mesenteric ischemia

Purpose

To evaluate the role of 64-multidetector CT in assessment of mesenteric vascular ischemia in clinically suspected patients.

Patients and methods

This study included 38 patients during period from October 2009 to October 2011. The patients age ranged from 38 to 72 year old (mean age was 57 ± 11.2 years). All cases met the criteria of acute non traumatic (28 patients) or chronic abdominal pain (10 patients) and suspected mesenteric vascular ischemia. All 38 cases were evaluated in surgery department, then underwent CT of the abdomen and pelvis & CTA by using 64 multislice GE light speed VCT. MDCT& CT angiographic findings were correlated with surgical findings in acute mesenteric ischemia (AMI) cases & conventional angiography in chronic mesenteric ischemia (CMI) cases.

Results

MDCT findings alone were nonspecific for detection of MI. The sensitivity, specificity& accuracy of CTA in diagnosis of AMI after surgical confirmation were 96%, 66.6% & 92.8% respectively, while in CMI the sensitivity, specificity & accuracy were 88.8%, 100%, 90% respectively, after confirmation by conventional angiography.

Conclusion

CTA scan appears to be an excellent tool to find out and localize cases of AMI rather than in CMI cases.     

急性非闭塞性肠系膜血管缺血的诊断和介入治疗

目的探讨选择性肠系膜上动脉造影,经肠系膜上动脉持续灌注罂粟碱在诊断和治疗急性非闭塞性肠系膜血管缺血(NOMI)的价值。方法回顾分析从1999年8月到2005年3月经选择性肠系膜上动脉造影确诊,并行介入诊疗的18例NOMI。明确NOMI诊断后即行经导管肠系膜上动脉灌注罂粟碱治疗。结果本组18例NOMI中15例患者治愈;3例有效,介入治疗后腹痛减轻,但仍有局限性的腹膜刺激征,转外科行肠切除治愈;1例10d后死于严重肺部感染导致的呼吸衰竭。结论选择性肠系膜上动脉造影持续经导管肠系膜上动脉灌注罂粟碱是NOMI有效的诊断和治疗方法。     

慢性系膜动脉缺血的腔内治疗:我们理解了多少

收集并总结慢性系膜动脉缺血腔内治疗的临床资料.以"系膜动脉缺血"、"球囊血管成形"、"系膜动脉支架"和"肠坏死"为主题词经Medline搜索相关文献,对腔内治疗大于5例的文献进行分析.分析16个系列研究共328例患者.所有治疗指征都是症状型系膜动脉狭窄.治疗成功率91%.75%患者症状消失且不需要再次干预治疗.28%患者随访中发现再狭窄.9%出现了并发症,包括夹层、远端栓塞、中转为传统手术、感染及穿刺点部位血栓和出血等.30 d病死率3%.腔内治疗系膜动脉狭窄或闭塞安全、有效,支架植入有更高的技术成功率.但即使是腔内治疗非常成功,依然有三分之一的患者可能出现再狭窄.     

Acute mesenteric ischemia: recent advances in diagnosis and endovascular therapy

Acute mesenteric ischemia is a complex disorder associated with high morbidity and mortality. Recent advances in interventional radiology techniques have provided a variety of less invasive, endovascular approaches to the treatment of acute mesenteric ischemia. This article reviews the etiologies and imaging findings of acute mesenteric ischemia and describes evolving endovascular therapies.     

Post traumatic arterial occlusive mesenteric ischemia: a rare case report

Mesenteric ischemia is an uncommon condition with very high mortality rates characterized by inadequate blood supply, inflammatory injury, and subsequent necrosis of the bowel wall. Acute arterial mesenteric ischemia is usually caused by cardiac emboli, atherosclerotic vascular disease, aortic aneurysm, or dissection. We report a case of a 60-year-old male who presented to the accident and emergency department complaining of abdominal pain following blunt abdominal trauma. An urgent contrast enhanced computed tomography scan demonstrated superior mesenteric artery thrombosis with ischemic small bowel. Surgical intervention was carried out with resection of the necrotic bowel followed by anastomosis. Acute occlusive mesenteric ischemia needs to be considered in cases of blunt trauma presenting with abdominal pain. Proper early diagnosis and management is essential as it carries a high risk of morbidity and mortality.     

Value of endovascular stent placement for symptomatic spontaneous isolated superior mesenteric artery dissection

Objective

To evaluate the feasibility and efficacy of endovascular stent placement for the treatment of symptomatic spontaneous isolated superior mesenteric artery dissection.

Materials and methods

This retrospective study was undertaken in 12 consecutive patients who suffered from symptomatic spontaneous isolated superior mesenteric artery dissection. Seven patients with severe clinical symptoms underwent endovascular stent placement as a primary treatment and the other 5 patients received conservative treatment. The technical results, complications and clinical outcomes were analyzed. Follow-up was performed with computed tomographic angiography.

Results

Primary endovascular stent placement was successfully performed in 7 patients with severe clinical symptoms. Successful conservative treatment was achieved in 3 patients. Endovascular stent placement was additionally performed in 2 patients with unsuccessful conservative treatment. A stent was misplaced in the false lumen in one of those two patients due to a severely stenotic true lumen. The fasting time and length of stay were significantly shorter in patients with successful endovascular therapy (median: 3 days and 5.5 days) than in those conducted conservatively (median: 9 days and 14 days) (p < 0.05). During the follow-up period (median, 21 months; range, 10–36 months), 1 patient with endovascular stent placement had recurrent abdominal pain because of the wall adherent thrombus in the proximal segment of the superior mesenteric artery during the first follow-up month. No thrombosis or stenosis was found in the lumina of the stents.

Conclusion

Endovascular stent placement is a safe and feasible therapeutic approach for symptomatic spontaneous isolated superior mesenteric artery dissection with immediate success and satisfactory outcomes.