急性肠系膜缺血的DSA诊断和经皮血管内治疗的临床价值探讨

目的:探讨急性肠系膜缺血的DSA诊断价值和经皮血管内治疗的临床应用价值。方法:12例临床疑诊患者,均经皮行右侧股动脉穿刺、插管,依次进行升主动脉、腹主动脉、腹腔干和肠系膜上、下动脉造影。其中8被诊断为急性肠系膜缺血,急性肠系膜上动脉栓塞4例;急性肠系膜上动脉血栓形成3例,非闭塞性肠系膜缺血1例。对4例肠系膜上动脉栓塞患者经导管注入溶栓剂(尿激霉)和血管扩张剂(罂粟碱)治疗,2例治疗后血管开通;另2例因症状缓解不明显行外科手术治疗;3例病程较长者造影后直接转外科进行手术治疗。结果:DSA诊断急性肠系膜上动脉栓塞4例。造影表现为肠系膜上动脉主干远端(中结肠动脉起始部)或分支的突然截断(截断征)或管腔内局限性充盈缺损(不完全栓塞)。急性肠系膜上动脉血栓3例,造影表现为肠系膜上动脉起始部的狭窄。1例造影表现为肠系膜上动脉分支弥漫性痉挛(腊肠征)诊断为非闭塞性肠系膜动脉缺血,手术证实为急性肠系膜静脉血栓形成。手术后1周因再次肠坏死而死亡。1例广泛血栓形成患者于造影后6h死亡。另2例肠系膜上动脉血栓患者手术后2周死亡。结论:DSA是诊断各型急性肠系膜缺血的有效手段,可以明确病变的部位和范围,为手术治疗提供定位信息。对急性肠系膜静脉血栓的诊断有一定的局限性。经导管溶栓术是治疗肠系膜动脉栓塞的有效手段。亦可作为外科手术前的辅助治疗手段,减少死亡率。     

DSA在急性肠系膜上动脉栓塞诊治中的应用探讨

目的探讨数字减影血管造影术（DSA）对急性肠系膜上动脉栓塞的诊断与治疗效果。方法对2001-2007年收治的急性肠系膜上动脉栓塞患者10例的临床资料进行回顾性分析。结果10例患者均行肠系膜上动脉造影并溶栓，7例痊愈，3例溶栓失败，转为剖腹手术治疗后2例痊愈，1例死亡。结论早期DSA选择性肠系膜上动脉造影确诊并溶栓有利于提高患者的治愈率。     

急性肠系膜动脉栓塞9例的诊断与治疗分析

目的　探讨肠系膜动脉栓塞易误诊的原因及早期诊断和治疗。方法　总结 1 985— 2 0 0 0年间收治的 9例急性肠系膜动脉栓塞的诊治经验。结果　就诊时明确诊断 1例。9例均行手术治疗 ,抢救成功 3例 ,死亡 6例。结论　该病诊断困难 ,预后较差。只有提高认识 ,早期诊断 ,及时正确施治 ,方能提高疗效     

CT诊断肠系膜血管栓塞的价值

目的：探讨螺旋CT诊断急性肠系膜血管栓塞的价值。材料和方法：回顾性分析6例肠系膜血管栓塞患者的CT平扫和增强扫描的表现，并与手术病理结果对照评价其诊断价值。结果：手术结果与CT诊断相符5例，其中肠系膜上动脉栓塞2例和肠系膜上静脉栓塞4例。误诊为绞窄性肠梗阻1例。结论：螺旋CT能快速无创伤地诊断急性肠系膜血管栓塞。     

肠系膜上动脉栓塞1例救护体会

肠系膜上动脉栓塞病例临床少见，起病急骤，病情凶险，预后差，多因肠管大面积坏死而引起败血症，中毒性休克，多脏器功能衰竭而死亡。故早期发现早期诊断治疗尤为重要。我科收治1例78岁老年女性患者，诊断肠系膜上动脉栓塞。通过术前密切观察病情变化及及时的治疗，术后精心护理，获得较好效果，现报告如下。     

急性腹痛MSCT检查少见征象的分析

目的评价急性腹痛在MSCT中少见征象,提高MSCT诊断水平。方法回顾性分析2008年~2014年笔者所在医院经随访及手术证实的12例急性腹痛患者的临床资料及MSCT表现,对病变部位少见征象进行重点分析观察,提高MSCT诊断水平。结果肠脂垂炎3例,结肠憩室炎2例,十二指肠旁疝3例,脂肪瘤诱发小肠套叠2例,左侧闭孔疝1例,肠系膜上动脉血栓栓塞1例。结论认识急性腹痛MSCT少见征象,对提高急性腹痛病因诊断和临床治疗有重要意义。     

血管内栓塞术治疗急性消化道大出血

目的探讨血管内栓塞术在急性消化道大出血的临床应用。方法回顾性分析40例急性消化道大出血临床及影像学资料,其中胃左动脉出血10例,胃十二指肠动脉出血13例,肠系膜上动脉出血5例,肠系膜下动脉出血2例,脾动脉出血2例,肝动脉出血8例,经股动脉常规穿刺插管,分别行DSA造影,包括腹腔动脉,肠系膜上动脉,肠系膜下动脉,膈下动脉等,发现可疑出血点进一步超选择造影,明确出血动脉后,选择适宜的栓塞材料立即栓塞治疗,术后严密观察生命体征,一旦有变化再次造影栓塞。结果 40例患者中,一次栓塞成功38例,2例2次栓塞成功。术后随访3~6个月,未出现复发及严重并发症。结论血管内栓塞术治疗急性消化道大出血,迅速,准确、安全有效。     

小儿肠系膜囊肿30例分析

目的：了解小儿肠系膜囊肿的临床、病理、治疗、预后及其相互关系。方法：对30例经手术治疗的肠系膜囊肿病例进行回顾性分析。结果：复发性腹痛、腹胀、腹部肿物为主要症状和体征,急性腹膜炎、急性或慢性复发性肠梗阻为主要合并症。结论：根据本病的特点及影象学检查应早期诊断早期手术。     

肠系膜上动脉栓塞症的早期CT所见

急性肠系膜上动脉栓塞症是由于肠系膜上动脉闭塞致急剧缺血而引起的急腹症。作者应用CT检查2例早期急性肠系膜上动脉栓塞症。肠管梗塞CT见有肠管壁增厚、肠管扩张、肠管壁内水肿造成低密度影、肠管壁内气体、肠系膜脂肪内气体、肠系膜静脉和门静脉内气体、肠系膜血管闭塞、腹水、腹腔内气体。其中肠系膜动脉和静脉的闭塞是     

多层螺旋CT血管成像在急性肠系膜动脉栓塞疾病诊断中的应用

随着螺旋CT和多层螺旋CT技术的发展,CT血管成像在腹部的应用范围由大血管扩展到中小血管,多层螺旋CT血管成像在诊断急性肠系膜动脉栓塞疾病方面,已经成为一种有效的手段.本文综述了急性肠系膜上动脉栓塞的临床特征及多层螺旋CT血管成像在诊断肠系膜上动脉栓塞中的应用价值.     

介入取栓术治疗急性肠系膜上动脉栓塞临床研究

目的评价经皮肠系膜上动脉吸栓和(或)溶栓治疗急性肠系膜上动脉栓塞的疗效。方法34例急性肠系膜上动脉栓塞的患者(房颤14例;左房黏液瘤2例;血栓形成15例;慢性缺血性肠病急性发作3例),行经皮动脉长鞘吸栓术和(或)溶栓术。结果34例患者均成功的去除栓子,动脉开通。31例痊愈;2例行开腹探查;1例24h后死亡。结论经皮介入取栓术对于治疗急性肠系膜上动脉栓塞,是一种简便有效的方法。准确地判断病因是提高疗效,避免合并症的关键。     

Superior mesenteric artery embolism: treatment with intraarterial urokinase.

Four patients with a superior mesenteric artery (SMA) embolism were successfully treated with intraarterial urokinase. Angiography showed partial SMA occlusion by intraluminal thrombus in two cases and almost total occlusion in two cases. Laparotomy was performed in the latter two cases, one of which required resection of infarcted bowel. Several additional reports of partially occluding SMA emboli treated successfully with streptokinase were found in the literature. The use of intraarterial thrombolytic drugs is an important addition to the treatment of mesenteric embolism that, in some cases, can eliminate or simplify surgical management.     

Intra-arterial fibrinolysis of superior mesenteric artery embolism

Intra arterial fibrinolysis for acute mesenteric embolism. Acute mesenteric ischemia has a poor prognosis because the diagnosis is often too late (greater than 12 h), leading to a difficult surgery in old patients. The lesions of the bowel don't always allow a single operative embolectomy but often need a resection when there is a long time interval between onset of symptoms and therapy. We report a case of acute embolism in the superior mesenteric artery with the clot located in its terminal part. A rapid diagnosis was made by arteriography and intra-arterial fibrinolysis was attempted with success permitting the complete cure of the affection, without sequellae. This treatment is only likely to be successful if it is carried out within 10-12 hours of the onset of clinical signs and symptoms.     

Treatment of acute embolus of the superior mesenteric artery by topical infusion of streptokinase

Two patients with sudden onset of acute abdominal pain caused by embolic disease of the superior mesenteric artery (SMA) were evaluated angiographically. In one patient, the study was performed soon after the clinical onset of symptoms, and successful treatment with low-dose topical streptokinase infusion produced total lysis of the clot over a period of 30 h. In the second patient, the angiogram was obtained 6 days following the initial episode of pain. Radiographic and clinical findings indicated advanced gastrointestinal ischemia with bleeding which contraindicated the use of fibrinolytic therapy. Surgical resection of infarcted intestine was required. Early angiographic detection of acute mesenteric thrombus or embolus is crucial for the selection of patients for fibrinolytic therapy. Our cases suggest that with early diagnosis, streptokinase infusion is an alternative to surgical management of selected patients with acute mesenteric ischemia.     

Successful Percutaneous Transluminal Angioplasty and Stenting in Acute Mesenteric Ischemia

Acute mesenteric ischemia (AMI) is a life-threatening emergency. The complications are high by the time of diagnosis in most cases and therefore only few data on primary percutaneous intervention with percutaneous transluminal angioplasty (PTA) and stenting in AMI are available. We present the case of an 84-year-old woman who presented to our emergency department complaining of an acute worsening of pre-existing abdominal periumbilical pain, nausea, vomiting, and diarrhea. She had previously undergone percutaneous transluminal embolectomy for an acute occlusion of the left common femoral artery. Due to suspicion of intestinal infarction, conventional angiography of the aorta and the superior mesenteric artery (SMA) was performed and confirmed a proximal occlusion of the SMA. Percutaneous SMA recanalization with balloon dilation and subsequent stent implantation was carried out successfully. The abdominal symptoms subsided after this procedure. In AMI that is diagnosed early, endovascular stenting should be considered as an alternative treatment to the surgical approach that avoids the need for surgical bowel resection.     

双源CT双期增强血管成像对急性肠缺血的诊断

目的:探讨双源CT(DSCT)双期增强扫描血管成像对急性肠缺血(acute mesenteric ischemia,AMI)患者的诊断价值。方法:回顾性分析经手术或介入治疗证实的26例AMI患者的DSCT资料。所有患者均行DSCT双期增强扫描即动脉期和门静脉期血管成像。结果:肠系膜上动脉栓塞8例,肠系膜上动脉血栓形成4例,肠系膜上静脉血栓形成14例。CT直接征象为肠系膜血管内低密度充盈缺损,受累血管腔闭塞(17例)或重度狭窄(9例)。间接征象:肠壁增厚(21例),肠管扩张、肠腔内积液积气(18例),肠壁强化程度降低(7例),肠壁积气(5例),肠系膜脂肪水肿及渗出(19例),"缆绳征"14例,腹腔积液12例。结论:DSCT增强扫描及双期血管成像可清楚显示AMI血管阻塞的部位、范围、程度及继发改变,对明确诊断和指导治疗具有较高的应用价值。     

Thrombolytic therapy for acute superior mesenteric artery occlusion

The aim of this review is to evaluate thrombolytic therapy for acute superior mesenteric artery occlusion as an alternative or adjunctive treatment modality to surgical therapy and to provide current knowledge for timely and informed decisions regarding treatment of acute mesenteric ischemia. A systematic analysis of the available literature from 1966 to 2003 regarding thrombolytic therapy for superior mesenteric artery thromboembolism was performed. A total of 20 case reports and seven small series covered 48 patients with acute superior mesenteric artery thromboembolism. In the herein reviewed series, thrombolytic therapy of acute superior mesenteric artery thromboembolism resulted in angiographic resolution of the thromboembolism in 43 patients, in clinical success without requiring additional surgical intervention in 30 patients, and in survival in 43 patients, with similar complication rates as in thrombolytic treatment of peripheral vascular occlusions. Remission of abdominal pain during the first few hours of treatment formed the most important indicator of therapeutic success. Insufficient evidence from reviewed literature is available to determine the relative effectiveness and safety of thrombolytic treatment for acute superior mesenteric artery thromboembolism; however, initial results appear to be promising. Thrombolytic therapy can be effective relatively quickly, may obviate surgery, and has the potential to resolve the clot completely. In some cases it can be used as an alternative or neo-adjunctive treatment modality to surgery. A treatment guideline for thrombolysis of acute superior mesenteric artery thromboembolism should be developed.