肝硬化患者进食前后肾动脉和肠系膜上动脉阻力指数的变化

目的：探讨多普勒超声测定肾动脉和肠系膜上动脉阻力指数(RI)变化，推断肝硬化合并肾功能不全肾外血管扩张、肾动脉收缩是否成立。方法：受试者为28例肝硬化患者，对照组为30例健康人。将肝硬化患者依据肌酐清除率是否正常，分为异常组(A组)和正常组(B组)。在进食前后用HDL-5000型彩色多普勒超声仪检测肠系膜上动脉和肾动脉RI。结果：进食前，肝硬化组的肾动脉RI大于对照组，而肠系膜上动脉的RI两组比较差异无显著性意义；进食后，两组受试者的肠系膜上动脉RI明显降低，肾动脉的RI明显增高。A组在餐前就存在肠系膜上动脉RI降低、肾动脉RI增高。结论：肝硬化患者，尤其是合并肾功能不全者存在肠系膜上动脉扩张和肾动脉收缩，多普勒超声测定RI对评价肝硬化合并肾功能损害有较好的价值。     

Pulsatility index of superior mesenteric artery blood velocity waveforms

A transcutaneous Doppler ultrasound technique was used to investigate superior mesenteric artery blood velocity waveforms in normal subjects. The shape of the waveforms was quantified by means of the pulsatility index (PI). The mean value +/- standard error of the mean of the PI measured in 82 normal subjects in the resting and fasting state was 3.57 +/- 0.11. There was no difference in the PI between sexes nor correlation between the PI and age. Following the ingestion of a meal in a group of 15 subjects the PI decreased by 46% (p less than 0.001). A significant fall persisted over the next two hours.     

肠系膜上动脉与腹主动脉间隙面积诊断肠系膜上动脉综合征

目的 探讨肠系膜上动脉(SMA)与腹主动脉(AO)间隙面积对肠系膜上动脉综合征(SMAS)的诊断价值。方法 收集接受腹部CT增强检查的24例SMAS患者(SMAS组)及42例非SMAS患者(非SMAS组),测量SMA-AO间隙面积、夹角、经十二指肠水平部中心SMA-AO距离及SMA起始部至十二指肠水平部中心水平距离,并进行统计学分析。结果 两组SMA-AO间隙面积、夹角、经十二指肠水平部中心SMA-AO距离及SMA起始部至十二指肠水平部中心水平距离差异有统计学意义(P均<0.05),ROC分析显示SMA-AO间隙面积、夹角、经十二指肠水平部中心SMA-AO距离及SMA起始部至十二指肠水平部中心水平距离的ROC曲线下面积分别为0.997、0.783、0.867及0.751。结论 SMA-AO间隙面积对诊断SMAS具有较高的准确率,可作为诊断SMAS的参考标准。     

Isolated dissection of the superior mesenteric artery

Dissection of the superior mesenteric artery (SMA) not associated with aortic dissection is rare. The purpose of this study is to describe the computed tomographic (CT) findings of this condition. We studied the CT findings of six patients with isolated dissection of the SMA. CT demonstrated thrombosis of the false lumen or intramural hematoma (n = 4) and/or intimal flap (n = 4) in all six patients. Other CT findings were enlarged diameter of the SMA (n = 5), increased attenuation of the fat around the SMA (n = 5), and hematoma in the mesentery with hemorrhagic ascites (n = 1). CT is useful for the diagnosis of isolated dissection of the SMA, and increased attenuation of the fat around the artery is considered the key to the diagnosis when no definite findings are evident.     

Aneurysms of the superior mesenteric artery and its branches

Aneurysms of the superior mesenteric artery (SMA) and its branches are rare. We describe three patients with aneurysms in the SMA or its branches found at angiography in our department. The importance of mesenteric aneurysms and different procedures for treatment are discussed.     

The ratio of superior mesenteric artery diameter to superior mesenteric vein diameter based on non-enhanced computed tomography in the early diagnosis of spontaneous isolated superior mesenteric artery dissection

BACKGROUND:Spontaneous isolated superior mesenteric artery (SMA) dissection (SISMAD) is a rare cause of abdominal pain. The aim of the study is to investigate the role of a new parameter, the ratio of the SMA diameter to the superior mesenteric vein (SMV) diameter (SMA/SMV) based on non-enhanced computed tomography (CT), in the early diagnosis of SISMAD.METHODS:In a registry study from December 2013 to June 2021, 97 abdominal pain SISMAD patients (SISMAD group) admitted to our hospital were enrolled. Meanwhile, the matched sex and age abdominal pain non-SISMAD patients at 1:2 were collected in reverse chronological order as the control group. Student’s t-test, Wilcoxon rank-sum test, and Chi-square test were used to compare differences between the SISMAD and control groups. MedCalc was used to generate receiver operating characteristic (ROC) curve.RESULTS:A total of 291 abdominal pain patients, including 97 SISMAD patients and 194 non-SISMAD patients, were included in the current study. The maximum SMA diameter, perivascular exudation, and SMA/SMV based on non-enhanced CT were significant between the two groups (all P<0.05). ROC curves showed that for the maximum SMA diameter, the area under the curve (AUC), cut-off, sensitivity, and specificity were 0.926, 9.80, 93.8%, and 79.4%, respectively. For SMA/SMV, its AUC, cut-off, sensitivity, and specificity were 0.956, 0.83, 88.7%, and 92.3%, respectively. The diagnostic efficiency of SMA/SMV was better than that of the maximum SMA diameter (P<0.05). The combined parameters of SMA/SMV and maximum SMA diameter had the best diagnostic efficiency (AUC=0.970).CONCLUSION:SMA/SMV may be a potential marker for SISMAD.     

Scoliosis, superior mesenteric artery syndrome, and adolescents

Adolescent idiopathic scoliosis is defined as a lateral curvature of the spine that can occur in any region of the spinal column. For curves that require surgical correction, spinal fusion is the surgical treatment, and superior mesenteric artery syndrome is a possible complication. Risk factors for superior mesenteric artery syndrome include a small aorta-superior mesenteric artery angle, spinal lengthening, and an asthenic habitus. Asthenic habitus may be due to natural build, peptic ulcer disease, or anorexia, especially among adolescent females. Research regarding adolescent idiopathic scoliosis and superior mesenteric artery syndrome is warranted to identify if some adolescents are more likely to develop superior mesenteric artery syndrome. The advanced practice nurse can identify which adolescents may develop superior mesenteric artery syndrome and provide safe care to avoid this complication.     

肠系膜上动脉综合征的护理18例

肠系膜上动脉综合征(SMAS)临床上并不多见,它是由于各种原因导致的十二指肠水平部被压迫于肠系膜上动脉与腹主动脉、脊柱之间而引起十二指肠近端梗阻的一种疾病,故临床又称为十二指肠淤滞症[1]。1990年1月-2004年9月,我院曾对18例患肠系膜上动脉压迫综合征的患者施行手术治疗,对患者进行系统的整体护理,使患者更好地配合手术治疗,减少术后并发症的发生,提出了更高的要求,现将护理报道如下。临床资料1.一般资料。本组18例,男9例,女9例,年龄12～40岁,平均年龄27.6岁。病程3h～16a。18例患者均有上腹疼痛、腹胀症状,伴恶心、呕吐14例,呕吐物…     

CT诊断自发性肠系膜上动脉夹层

自发性肠系膜上动脉夹层(spontaneous dissections of the superior mesenteric artery)是临床罕见的血管性疾病,文献报道较少,由Bauersfeld在1947年首次报告.本文回顾性分析4例自发性肠系膜上动脉夹层病例,探讨多层螺旋CT血管造影(computer tomography angiography,CTA)诊断该病的价值.     

Ultrasonic evaluation of the superior mesenteric artery.

With the use of gray scale B scan ultrasound, it is now feasible in many cases to detect portions of the superior mesenteric artery (SMA) arising from the aorta. Thus, it is possible to measure the aortomesenteric angle and distance. We evaluated a series of patients by ultrasound to determine the normal values for the SMA angle, distance, and lumen diameter. Patients were also examined who had pathological conditions that might produce an alteration in the angle and distance. Abnormal widening was observed in patients with aortic aneurysms and para-aortic lymphosarcomatous nodes. In patients suspected of having duodenal ileus, there was evidence of narrowing of the superior mesenteric artery angle and distance. However, a comparable group of asymptomatic patients of the same age showed a similarly narrowed angle and distance. It was thus concluded that the narrowing of the aortomesenteric angle and distance is not a cause of duodenal ileus. Knowledge of the SMA and aortic lumen diameter has been helpful in selecting the proper catheter and approach for selective arteriography.     

急性肠系膜上动脉缺血性疾病的诊断

急性肠系膜缺血(acute mesenteric ischemia, AMI)是一种以急性腹痛为主要临床表现的外科急症,治疗不及时可导致肠坏死,死亡率高达60%～80%[1].早期准确诊断AMI是避免肠坏死、降低死亡率、提高患者生存质量的前提条件.AMI并非一种单一疾病,而是由急性肠系膜上动脉栓塞、急性肠系膜上动脉血栓形成、急性肠系膜上静脉血栓形成和非阻塞性肠系膜缺血组成的疾病群[2].     

肠系膜动脉供血障碍性肠缺血肠管可逆性CT表现探讨

目的探讨肠系膜上动脉和肠系膜下动脉供血障碍肠管可逆性改变的MSCT表现。方法回顾性分析21例经治疗恢复的肠缺血患者的CT表现特征,观察病变肠系膜上动脉、肠系膜下动脉表现及相应供血肠管的异常表现,将缺血肠管与正常对照组肠壁CT表现进行比较,所得的数据进行统计学分析。结果 21例中,肠系膜上动脉病变14例,肠系膜下动脉病变2例,5例肠系膜上、下动脉均有异常。19例小肠缺血表现为肠管扩张,管径为20.05±1.99 mm,管径大于正常对照组(15.36±0.74 mm,P0.05);肠腔内积液13例,例数多于对照组(P0.05)。于静脉期增强,小肠壁呈不均匀强化,平均CT值为42.77±4.33 HU,低于对照组(85.53±2.68 HU,P0.05),小肠黏膜强化中断16例,例数高于对照组(P0.05)。7例结肠缺血患者,肠管的径线为24.02±1.55 mm,对照组径线为19.73±1.88 mm,两者差异无统计意义(P0.05);结肠肠腔内积液3例,与对照组(2例积液)比较无统计学差异(P0.05);静脉期增强,病变结肠壁平均CT值为33.14±4.02 HU,低于对照组(CT值为63.63±6.50 HU,P0.05);病变结肠黏膜强化连续性中断5例,对照组结肠黏膜强化连续性中断2例,两者比较无统计学差异(P0.05)。以上小肠和结肠的缺血性改变,治疗后复查均恢复正常。结论肠系膜动脉供血障碍性肠缺血可逆性改变的多排螺旋CT征象为肠管轻度扩张,肠腔内积液增多,肠管壁不均匀强化、肠黏膜强化不连续,而小肠改变较结肠改变显著,是诊断可逆肠缺血的重要依据,具有一定的临床价值。     

Duplex ultrasonography of superior mesenteric artery: interobserver variability

The aim of this study was to evaluate the interobserver variability during duplex ultrasonographic investigation of the SMA. Eleven healthy volunteers were examined twice under the same conditions by two independent observers. Three basic Doppler wave parameters were assessed for the SMA: pV, edV, and rT. The tD was recorded for SMA and abdominal aorta (AotD) with B-mode imaging. The interobserver variability was very low for all parameters: pV = 13.5 cm/s; edV = 3.4 cm/s; rT = 0.01 s; tD = 0.3 mm; AotD = 0.5 mm, with corresponding 95% confidence intervals as follows: pV = 19 cm/s; edV = 4.7 cm/s; rT = 0.015 s; tD = 0.4 mm; and AotD = 0.75 mm. Coefficients of variation also showed very low dispersion for results obtained. Under the appropriate standard conditions for duplex sonographic examination of the mesenteric artery, assessments of basic Doppler wave parameters do not differ significantly between independent investigators. Reliable evaluation of B-mode distances can be obtained by replication of measurements.     

自发性孤立性肠系膜上动脉夹层的治疗

目的:探讨自发性孤立性肠系膜上动脉夹层(SISMAD)治疗方法的选择。方法:回顾性分析2008-02-2014-01收治的29例SISMAD患者的临床资料。最初保守治疗25例,其中5例保守治疗无效后改行血管腔内治疗;急诊手术4例,均行小肠切除,其中1例行肠系膜上动脉切开取栓+内膜部分切除术,1例小肠切除前行肠系膜上动脉溶栓+支架植入术。结果:20例保守治疗有效;CTA随访显示假腔血栓部分或大部溶解(14例)或夹层无变化(2例)。血管腔内治疗获满意效果,CTA随访显示假腔消失或血栓形成,真腔通畅。4例开放手术中,1例死亡,其余3例均恢复良好。结论:大多数SISMAD保守治疗有效,若腹痛持续或加重,应适时中止保守治疗,改行腔内治疗;外科手术适合于夹层所致肠缺血坏死或动脉瘤破裂。     

肠系膜上动脉血栓栓塞的早期影像学诊断及介入治疗

目的评价肠系膜上动脉(SMA)血栓栓塞的早期影像学诊断及介入治疗的应用价值。方法选取SMA血栓栓塞患者72例为研究对象,按照随机数字表法分为两组,研究组使用介入疗法,对照组使用保守疗法,记录两组治疗有效率,随访1个月对死亡率和疾病复发率进行记录,评价治疗安全性。结果对72例患者进行血管造影,发现主干动脉、回肠动脉、空肠动脉、肝动脉胃十二指肠动脉栓塞的例数分别为53例(73.61%)、6例(8.33%)、9例(12.50%)、4例(5.55%),充盈缺损长度为4.3～9.7 cm,无肠坏死,50例(69.44%)肠腔积液、积气,9例(12.50%)显示出现内膜片;研究组治愈、无效分别为30例(83.33%)、2例(5.56%),总有效率为94.44%,对照组总有效率仅为77.78%,差异有统计学意义(P 0.05);研究组、对照组安全性事件发生率分别为1例(2.77%)、4例(11.11%),其中研究组没有死亡患者,复发率为1例(2.77%),对照组有1例(2.77%)死亡,复发率为3例(8.33%)。结论血管造影联合介入治疗用于急性SMA血栓栓塞患者早期诊断和治疗的有效率、安全性较高。