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《中华临床医师杂志(电子版)》2016,(11)
肠系膜静脉血栓(MVT)是造成肠系膜缺血的一种疾病,引起肠壁营养障碍及运动障碍,MVT发病率低于其他血管疾病,但临床常因缺乏及时有效的诊断及治疗,病死率极高。MVT形成分为原发性MVT和继发性MVT两类,原发性MVT常无明确诱因,继发性MVT形成常继发于血液高凝状态、门静脉高压、腹腔内脏感染、创伤及手术,实验室检查常不能提供早期诊断线索,随着增强CT、超声、血管造影、核磁等辅助检查技术的发展,使MVT的早期诊断成为可能,早期有效的抗凝、溶栓治疗,降低了肠管坏死风险,使外科手术概率及死亡率下降。现就MVT的流行病学、发病原因、病理变化、临床表现、诊断及治疗的研究情况概述如下。 相似文献
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患者男,68岁,因上腹部隐痛2个月,加重伴呕吐1d入院查体:生命体征平稳。痛苦面容,腹平坦,腹肌稍紧,剑突下、右上腹压痛明显,无反跳痛,未扪及明显包块回声,肠鸣音减弱。CT检查动脉期见肠系膜上动脉上段较粗,下段弯曲变细不明显, 相似文献
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【例 1】 男 ,37岁。因左上腹持续性剧痛 ,门诊以腹痛待查收入院。查体 :腹部平坦 ,无明显固定压痛点 ,无腹肌紧张 .腹部X线透视未见异常。血白细胞 1 6 0× 1 0 9/L ,中性粒细胞 0 90。入院后患者频繁呕吐 ,开始为胃内容物 ,4小时后呕吐淡红色液 ,并出现腹泻 ,大便呈洗肉水样 ,便次逐渐增多并呈果浆色。很快出现腹胀 ,肠鸣音减弱 ,呼吸急促 ,呼吸 30 /min,心率 1 2 0 /min ,血压 90 / 60mmHg ,且呈下降趋势 ,出现休克症状。予补充血容量、解痉、胃肠减压等急救措施 ,病情急剧恶化 ,入院 6小时死亡。【例 2】 男 ,30岁。因腹… 相似文献
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A unique case with superior mesenteric artery aneurysm and arterioportal fistula resulting from mesenteric arteriovenous
malformation is presented, and the relevant literature is reviewed.
Received: 16 December 1994/Accepted after revision: 31 March 1995 相似文献
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Chronic mesenteric ischemia: stenting of mesenteric arteries 总被引:11,自引:0,他引:11
This article focuses on stent placement in mesenteric arteries in patients with the rare diagnosis of chronic mesenteric ischemia.
We present a survey from the initial stage of recognition of this gastrointestinal disorder and its manifestations to treatment
by stenting to avoid further ischemic episodes and bowel infarction and necrosis. The advantages of stent placement in splanchnic
arteries are discussed in comparison to open surgical revascularization. 相似文献
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Kang H Manasia A Rajamani S Rajaram SS Hannon E Lu Y Oropello JM Benjamin E 《Critical care medicine》2002,30(11):2528-2534
OBJECTIVE: To evaluate the effect of an intravenously administered synthetic epoprostenol analog, iloprost, in nonocclusive acute mesenteric ischemia induced by cardiac tamponade. DESIGN: Prospective, randomized, controlled experimental study. SETTING: Animal research laboratory at a university medical center. SUBJECTS: Ten Yorkshire pigs (weight range, 20-25 kg). INTERVENTIONS: Nonocclusive acute mesenteric ischemia was induced by pericardial tamponade. Pigs were randomized to receive either a low-dose, continuous intravenous infusion of iloprost (0.075 microg/kg/min) or an equivalent volume of normal saline to serve as the control. Infusion of iloprost or saline was continued after pericardial tamponade was reversed. METHODS: Ten anesthetized and ventilated pigs underwent laparotomy and thoracotomy. A pulmonary artery catheter was inserted, a magnetic flow probe was positioned around the superior mesenteric artery (SMA), and cannulation of the pericardial space was performed. Pericardial tamponade was induced by injecting 5% dextrose in water into the pericardial space until blood flow in the superior mesenteric artery decreased to half of baseline. After 60 mins, animals received either a continuous intravenous infusion of iloprost at 0.075 microg/kg/min (n = 6) or an equal volume of normal saline (n = 4) for 60 mins. Pericardial fluid was then removed, and iloprost or normal saline infusion was continued for another 60 mins. MEASUREMENTS: Heart rate, blood pressure, cardiac output, oxygen delivery, oxygen consumption, SMA blood flow, ileal Pco2, ileal intramucosal pH, and serum lactate levels of mixed venous blood and mesenteric venous blood were recorded at baseline, after pericardial tamponade was induced, during the iloprost or normal saline infusion with pericardial tamponade, and after removal of pericardial fluid (reperfusion period). RESULTS: Iloprost infusion increased SMA blood flow by 60% in this model of nonocclusive mesenteric ischemia (from 168 +/- 41 to 269 +/- 76 mL/min; p <.05). The effect of iloprost infusion was more prominent after the tamponade (422 +/- 87 mL/min in the iloprost group vs. 232 +/- 111 mL/min in the control group; p <.05). Increased mesenteric perfusion decreased intestinal mucosal hypercarbia, leading to improvement of intramucosal pH. 相似文献
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T Ito H Nakahara M Ikeda F Kuranishi Y Ogawa Y Kuroda K Watanabe 《Southern medical journal》1990,83(3):330-331
We have presented a case of mesenteric desmoid tumor, with analysis of 21 such cases previously reported in Japan. 相似文献
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A mesenteric cyst is an uncommon cause of a palpable abdominal mass. A correct preoperative diagnosis can be made by the combined use of radiographic and sonographic examinations in conjunction with the clinical features. A patient with a retroperitoneal cyst extending into the leaves of the mesentery is presented. The cyst recurred 4 years after surgery. 相似文献
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Aschoff AJ Stuber G Becker BW Hoffmann MH Schmitz BL Schelzig H Jaeckle T 《Abdominal imaging》2009,34(3):345-357
The purpose of this study was to explore the accuracy of multi-detector row helical CT (MDCT), using a biphasic mesenteric
angiography protocol for evaluation of acute mesenteric ischemia (AMI). In total, 79 consecutive patients with clinical signs
of AMI underwent contrast enhanced 16- or 40-channel MDCT. MDCT findings were correlated with surgery, endoscopy and clinical
outcome. Sensitivity, specificity, and positive and negative predictive values were calculated using the patients in which
AMI had been excluded as a control group. In 28 patients the final diagnosis was AMI. In 27 patients (96.4%) MDCT correctly
diagnosed AMI (specificity of 97.9%). A sensitivity of 93%, specificity of 100%, and positive and negative predictive values
of 100% and 94%, respectively were achieved for the CT findings of visceral artery occlusion, intestinal pneumatosis, portomesenteric
venous gas or bowel wall thickening in combination with either portomesenteric thrombosis or solid organ infarction. Our findings
suggest that mesenteric MDCT angiography is an accurate tool for fast diagnostic work-up of patients with suspected AMI. 相似文献