急性肠系膜血管缺血性疾病的诊断和治疗

目的探讨急性肠系膜血管缺血性疾病（AMI）的诊断和治疗方法。方法回顾性分析26例AMI患者的临床资料。结果本组15例CT平扫诊断5例,10例行64排螺旋CT扫描及三维重建诊断8例,行血管造影者9例诊断7例。22例行急诊手术（肠系膜上动脉取栓4例,肠切除18例）;4例采用以溶栓为主的非手术治疗。12例痊愈出院,死亡10例。结论多排螺旋CT肠系膜血管成像和血管造影有助于AMI的早期诊断。早期手术治疗可降低病死率。     

急性肠系膜上动脉闭塞血运重建术38例回顾分析

目的探讨急性肠系膜上动脉闭塞的诊断、不同术式治疗和预后。方法获得随访的38例急性肠系膜上动脉闭塞患者,多表现为急性腹痛,术前均经CT血管造影诊断为肠系膜上动脉闭塞。综合分析患者病因、病情和辅助检查,采用置管溶栓、导管取栓、自体静脉或人工血管旁路转流术、球囊扩张支架植入等个体化的外科治疗方案进行肠系膜上动脉的血运重建术。伴肠坏死的患者行肠切除术。结果术后患者均随访半年。30例患者术后血运重建良好,彩超复查见肠系膜上动脉血流通畅。术后出现短肠综合征4例,3例死亡;肠瘘2例,1例死亡;多器官衰竭/脓毒症3例,2例死亡;再灌注损伤6例;原伴发疾病加重6例,2例死于急性心功能衰竭。术后并发症总出现率为55.2%,术后总死亡率为21.1%。结论术前选择合适手段及早明确诊断,并尽快应用个体化的血运重建术能显著改善急性肠系膜上动脉闭塞患者的预后。     

急性肠系膜上动脉栓塞46例诊治体会

［摘要］　目的　探讨急性肠系膜上动脉栓塞（acute superior mesenteric artery embolism,ASMAE）早期诊断及早期治疗要点,避免误诊,降低致残及致死率。方法　对2004-01～2011-01该院收治的46例ASMAE患者的临床资料进行回顾性分析。结果　病程1 h～10 d,46例均经上腹CT及腹部计算机断层X线血管造影(CTA)检查确诊为ASMAE。手术切除肠管28例,经皮介入肠系膜上动脉置管溶栓10例,肠系膜上动脉切开取栓血管再成型8例。围手术期死亡5例,短肠综合征8例,随访3年死亡,其余33例随访3年,恢复良好。结论　如出现突发剧烈腹痛和不典型的腹部体征,应警惕是ASMAE,尽早行腹部CTA检查,早期确诊、早期治疗是降低致残及致死率的关键。     

急性肠系膜动脉缺血性疾病的诊治分析——附27例报道

目的:探讨急性肠系膜动脉缺血的诊断和治疗方法。方法:回顾性分析自2002年5月至2008年12月我院共收治肠系膜动脉缺血性疾病患者27例。急诊行手术治疗21例,其中单纯行肠系膜上动脉取栓术9例,肠系膜上动脉切开取栓加肠切除吻合术8例,单纯肠切除吻合术3例,肠切除加肠造瘘术1例。保守治疗6例。结果:手术治疗21例,1例于死于感染性休克,5例出现短肠综合征,经胃肠外营养等对症治疗后症愈出院,6例行保守治疗者均症状减轻,好转出院。结论:彩超是早期诊断肠系膜动脉缺血的重要手段,及时手术和加强术后监护是提高疗效的关键。     

急性肠系膜上动脉栓塞的诊断与治疗

急性肠系膜上动脉栓塞的诊断与治疗山东省立医院（２５００２１）吴泰璜王雷常宏１急性肠系膜上动脉栓塞（ＡＳＭＡＥ）的病因与病理１．１病因本病多见于老年伴心血管疾病者，男性以动脉硬化性心脏病多见，女性以风湿性心脏病多见。栓子主要来源于心血管疾病。风湿性心脏...     

CDFI在诊断急性肠系膜上动脉狭窄或闭塞性肠缺血中的临床应用

目的探讨彩色多普勒血流显像（CDFI）诊断肠系膜上动脉狭窄或闭塞性肠缺血的临床价值。方法选择18例经数字减影血管造影（DSA）证实为肠系膜上动脉狭窄或闭塞性肠缺血的患者,回顾性分析其术前1周CDFI和DSA检查结果,并以后者为金标准判定前者诊断肠系膜上动脉狭窄或闭塞性肠缺血的准确率。结果本组术前CDFI与DSA检查结果基本一致,CDFI诊断肠系膜上动脉狭窄或闭塞性肠缺血的准确率为90％。结论CDFI诊断肠系膜上动脉狭窄或闭塞性肠缺血准确率高,且具有无创、应用方便、经济适用等特点。     

急性肠系膜血管闭塞41例早期诊治体会

目的探讨急性肠系膜血管闭塞（AMVO）的早期诊断及治疗方法。方法回顾性分析41例AMVO患者的临床特征、早期诊治方法及预后情况。结果AMVO41例中,肠系膜上动脉栓塞20例,肠系膜上动脉血栓形成5例,肠系膜上静脉血栓形成12例,非阻塞性肠系膜血管供血不全4例。41例均急诊行剖腹探查术,2例因病变广泛未能切除坏死肠段,39例行肠切除肠吻合术。治愈37例,死亡4例。结论早期诊断和及时剖腹探查是提高AMVO疗效的关键。     

老年人缺血性肠病的诊治进展

随着人口老龄化趋势加剧及人们生活方式的改变,缺血性肠病(IBD)的发病率逐年升高,50岁以上的中老年人已成为IBD的主要发病人群。近年来发现血清生物学标志物SM22、平均血小板体积(MPV)、CT血管造影(CTA)、多排螺旋CT(MDCT)对急性肠系膜缺血(AMI)的诊断具有较高的敏感度和特异度;磁电图(MENG)能识别慢性肠系膜缺血(CMI)患者肠道慢波节律,可提高CMI的诊断效率。经肠系膜动脉血管成形术和支架植入术可作为伴有慢性疾病的老年AMI及CMI患者首选的治疗方法,在血运重建术后行吲哚菁绿(ICG)荧光灌注有利于提高AMI的治疗效果,从而降低病死率。     

缺血性肠病与心脑血管病变

1 缺血性肠病缺血性肠病在我国常见,是由各种原因引起肠道供血不足而形成的一组综合征,可表现为从轻的、可逆性的肠缺血到肠梗塞和肠坏疽,临床上分成急性和慢性两种类型,慢性缺血性肠病包括腹绞痛、腹腔动脉压迫综合征,急性缺血性肠病包括肠系膜上动脉栓塞和血栓形成、急性非肠系膜血管阻塞性肠梗塞、肠系膜静脉血栓形成和缺血性结肠炎,其临床表     

提高缺血性肠病的临床认识

缺血性肠病是一组因小肠、结肠血液供应不足导致的不同程度的肠壁局部组织坏死和一系列症状的疾病,可分为急性肠系膜缺血（AMI）、慢性肠系膜缺血（CMI）及缺血性结肠炎（IC）,以IC最多见。临床表现主要为腹痛、血性腹泻、血便及腹胀等消化道症状。该病与动脉粥样硬化、肠系膜动静脉栓塞及血栓形成、心搏量减少及血管炎等有关,患者可同时存在高血压、糖尿病及急性心肌梗死等老龄化疾病。DSA及CT检查对于诊断AMI及CMI价值较高,而IC则主要依赖于结肠镜的诊断。预后也各不相同,AMI病情凶险,死亡率高,须早期诊断及手术治疗;而IC临床症状多为自限性,预后良好。缺血性肠病临床误诊率较高,应引起临床医师重视。     

急性缺血性肠病临床诊治分析

目的 了解缺血性肠病的发病因素、临床表现及诊断治疗方法,尽可能地降低对该病的误诊、漏诊率,以提高对本病的诊疗水平.方法 通过对33例临床诊断缺血性肠病患者的诊断治疗过程进行回顾性分析,找出其临床特点.结果 33例缺血性肠病患者,临床上表现为腹痛、血便、腹泻或黏液血便等非特异性症状,早期不易确诊.严重者病情发展迅速,可出...     

Asian perspectives in the management of inflammatory bowel disease: Findings from a recent survey

Background and Aim:  The prevalence and incidence of inflammatory bowel disease (IBD) differs worldwide. While the prevalence of IBD has stabilized in Europe, the USA and Japan, an increasing trend has been observed in Asia. However, there are no data on the current clinical practice for the management of IBD in the region. The present study aims to investigate the number of existing and new cases of IBD and to understand the current practice of diagnosis and treatment of IBD in different Asian countries.
Methods:  A self-administered questionnaire, designed according to European and US guidelines, was distributed to IBD specialists throughout Asia. The questionnaire estimated the annual incidence of existing and new IBD cases in physicians' clinical practices and evaluated their procedures of diagnosis and preference for therapeutic treatment and maintenance treatment.
Results:  Eighty-seven questionnaires were received out of the 107 distributed. In the clinical practices of these 87 respondents, there were 502 existing and 73 new cases per year for ulcerative colitis (UC) and 202 existing and 32 new cases per year for Crohn's disease (CD). Colonoscopy and histology were the most commonly used methods for the diagnosis of UC and CD, but clinical practice regarding the diagnosis of IBD varied. The treatment of choice for mild-to-moderate UC and CD was 5-aminosalicylic acid (5-ASA), which is also the preferred choice for the maintenance treatment of UC and CD.
Conclusion:  Clinical practice with regards to IBD diagnosis and management varies within Asia.5-ASA is the preferred treatment and maintenance therapy for mild-to-moderate IBD.     

消化内镜在炎症性肠病诊治中的应用

炎症性肠病(IBD)的诊断与治疗仍有不少悬而未决的问题,加强消化内镜在IBD的诊断、鉴别诊断、指导治疗和随访中的应用,具有重要的临床应用价值。     

Comparison of serological markers of inflammatory bowel disease with clinical diagnosis in children

BACKGROUND: Our purpose was to study the concordance of serological tests for inflammatory bowel disease with clinical diagnosis established by traditional testing in children. METHODS: All children seen in our division who had IBD Diagnostic System (ie, pANCA, ASCA IgA, and ASCA IgG) performed over a 21-month period (June 1998 to February 2000) were identified. Their medical records were reviewed for basic demographics, test results (endoscopy, histology, and radiology), IBD Diagnostic System results, and patient symptoms/medications. Results of the IBD Diagnostic System were compared with several patient characteristics including age, sex, absence/presence of symptoms, medication use, disease activity and duration. RESULTS: One hundred seven patients were divided into 6 groups based on clinical diagnosis and IBD Diagnostic System results. The sensitivity, specificity and +/- predictive values of the IBD Diagnostic System for ulcerative colitis were 69.2, 95.1, 90.0, and 87.1%, respectively, and for Crohn's disease were 54.1, 96.8, 90.9, and 80.8%, respectively. Overall, the results of the IBD Diagnostic System were concordant with the clinical diagnosis in 76 of the 107 (71%) patients. CONCLUSIONS: In our experience, the specificity of IBD Diagnostic System is better than the sensitivity; the sensitivity is better for ulcerative colitis than Crohn's disease (69.2% vs 54.1%). The low sensitivity, especially for Crohn's disease, precludes the possibility that the IBD Diagnostic System can replace traditional studies when evaluating for inflammatory bowel disease. Though we do not exclude inflammatory bowel disease solely by IBD Diagnostic System results, it is reassuring to note that all patients without clinical evidence of inflammatory bowel disease also had negative IBD Diagnostic System results.     

Crohn''s Colitis Complicated by Superimposed Invasive Amebic Colitis

The clinical characteristics and endoscopic appearance of inflammatory bowel disease (IBD) may be very similar to those of amebic colitis. Physicians, especially in areas in which amebiasis is endemic, are familiar with this difficulty. Moreover, in individual cases, it may even be impossible to distinguish between the two conditions, since stool specimens, bowel biopsies, and serological studies may be negative for Entamoeba histolytica, even in the presence of invasive amebic colitis. Invasive amebiasis may rarely be superimposed on IBD, which further complicates the issue. We report here a young patient with a 7-yr history of Crohn's colitis proven histologically who developed invasive amebic colitis during steroid and 6-mercaptopurine treatment for active disease. Stool specimens, mucosal biopsies, and serological studies were negative for E. histolytica, and the diagnosis was established on pathological examination of a surgically resected bowel. Anti-amebic therapy should be considered in endemic areas in cases of persistent IBD.     

多层螺旋CT小肠增强造影在诊断炎症性肠病中的价值研究

目的评估多层螺旋CT小肠增强造影（MSCTE）在诊断炎症性肠病（IBD）中的价值。方法回顾性分析45例IBD患者的病史资料,总结其MSCTE的影像学表现特点,并与常规结肠镜检查结果进行对比分析。结果 45例IBD患者中克罗恩病（CD）29例,溃疡性结肠炎（UC）16例。CD患者中,25例MSCTE有阳性发现,最常见的为肠道管壁增厚（21例,72.4%）及肠周间隙模糊伴渗出（9例,31.0%）;发现病变的部位以回盲部及末端回肠最多（44.8%）;MSCTE表现与结肠镜检查结果对比,前者发现的病变部位与后者完全吻合的有15例（51.7%）,前者发现空肠病变部位而后者无法发现的有10例（34.5%）。UC患者中,只有6例MSCTE有阳性发现,其中肠道管壁增厚亦最多见（5例,31.3%）;发现病变的部位以结肠居多（31.3%）;MSCTE表现与结肠镜检查结果对比,前者发现的病变部位与后者完全吻合的只有5例（31.3%）,而后者发现病变部位而前者未发现的却有11例（68.7%）。结论多层螺旋CT小肠增强造影对于CD的诊断价值较高。可通过发现小肠可能的病灶来弥补常规结肠镜检查的不足。MSCTE对于UC的诊断价值有限。     

Ischemic bowel disease

Twenty-five cases with ischemic bowel disease seen over a period of 4 years are presented. Of these, 20 cases presented with acute symptoms and five with chronic symptoms. In the majority of patients, the diagnosis was established at operation and on histopathology. Occlusive disease of the superior mesenteric artery was the commonest cause of acute ischemia. Non-occlusive ischemia was not observed in any case. All the patients were treated by resection and anastomosis of the involved bowel. Vascular procedures were not carried out in any. No planned second-look procedures were carried out. Of the 20 acute cases, eight patients died and three developed complications. One chronic case died and there were no other complications in this group. We suggest that ischemic bowel disease should be considered while dealing with cases presenting as acute abdomen or with chronic abdominal pain.     

Concurrent Inflammatory Bowel Disease and Myelodysplastic Syndrome: Report of Nine New Cases and a Review of the Literature

Nine patients with concurrent myelodysplastic syndrome (MDS) and inflammatory bowel disease (IBD) were examined. Median age at diagnosis of these patients was similar to the usual age of patients at diagnosis of IBD only. There was a strong predominance of Crohn's disease (seven of nine cases), with an unusually high frequency of colorectal involvement (five of nine cases). Inflammatory bowel disease was diagnosed first in one patient, MDS first in five patients, and both diseases were diagnosed simultaneously in three patients. All patients had moderate or severe anemia. The prognosis of IBD was determined by MDS. These observations suggest that there is an unclear common pathogenesis of IBD and MDS and, consequently that patients with IBD and anemia of non-obvious origin should be evaluated for the presence of MDS.     

炎症性肠病相关性肝病的研究进展

炎症性肠病(inflammatory bowel disease,IBD)是一种累及回肠、结肠、直肠的特发性炎症性疾病,本病主要包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn’s disease,CD)。除常见的消化道症状外,研究发现IBD合并肝脏疾病较为常见,是IBD常见的肠外表现之一,其严重影响IBD的预后与转归。本文就IBD相关性肝病的分类和总结作一概述,以期为IBD及其肝脏病变的临床诊疗提供参考。     

Simultaneous occurrence of inflammatory bowel disease and thyroid disease

We report a case of simultaneous occurrence of inflammatory bowel disease (IBD) and Graves' disease. A review of reported cases of simultaneous onset of ulcerative colitis (UC) and autoimmune hyperthyroidism is presented. A discussion of the prevalence of thyroid disease in patients with UC and possible common autoimmune etiology is entertained. The concurrent presentation has implications for the diagnosis and treatment of both diseases. At the time of suspected initial presentation or exacerbation or preexisting IBD, we emphasize the need to consider both IBD and thyroid disease in the differential diagnosis for optimal patient management.