儿童慢性肠系膜缺血致急性肠坏死一例并文献复习

目的:探讨儿童慢性肠系膜缺血的临床特点及诊治方法,提高儿科医生对本病的诊疗水平。方法:回顾性分析首都医科大学附属北京儿童医院收治的1例12岁因慢性肠系膜缺血所致的急性肠坏死女性患儿,体重14 kg,身高115 cm,曾有6年餐后腹痛病史,以持续性腹痛3 d,伴呕吐入院。入院诊断为急性消化道穿孔。急诊行开腹探查,术中见空...     

Mesenteric panniculitis does not confer an increased risk for cancers: A systematic review and meta-analysis

Background:Mesenteric panniculitis (MP) is a non-specific, localized inflammation at the mesentery of small intestines which often gets detected on computed tomography. An association with malignant neoplasms remains unclear. We performed a systematic review and meta-analysis to examine the association of malignancy with MP.Methods:MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched for articles published from inception to 2020 that evaluated the association of malignant neoplasms with MP in comparison with control groups. Using random-effects method, a summary odds ratio (OR) estimate with 95% confidence intervals for malignant neoplasms in MP was estimated.Results:Four case-control studies reporting data on 415 MP patients against 1132 matched-controls met inclusion criteria and were analyzed. The pooled OR for finding a malignant neoplasm in patients with MP was 0.907 (95% CI: 0.688–1.196; P = .489). The heterogeneity was mild and non-significant. Also, there was no heightened risk of any specific type of malignancy with MP. Three more case-series with unmatched-control groups (MP: 282, unmatched-controls: 17,691) were included in a separate analysis where the pooled OR of finding a malignant neoplasm was 2.963 (95% CI: 1.434–6.121; P = .003). There was substantial heterogeneity in this group.Conclusion:This meta-analysis of matched controlled studies proves absence of any significant association of malignant neoplasms with MP. Our study also demonstrates that the putative association of malignancy with MP is mainly driven by uncontrolled studies or case-series.     

急性肠系膜上动脉血栓形成的螺旋CT诊断

目的:分析急性肠系膜上动脉血栓形成的临床特点及螺旋CT表现,提高认识水平.方法:回顾性分析7例经手术证实为肠系膜上动脉血栓形成的螺旋CT表现.7例均行平扫加增强扫描,及最大密度投影图像后处理重建.结果:7例增强均显示肠系膜上动脉血栓形成的直接征象为肠系膜上动脉管腔充盈缺损.螺旋CT平扫5例出现肠系膜上动脉密度增高,4例肠系膜上静脉与肠系膜上动脉管径比例<1,4例肠系膜上动脉壁斑片状钙化,2例肠腔淤积扩张,2例薄纸样肠壁及腹腔积液等征象.7例最大密度投影重建显示肠系膜上动脉血管内不同程度充盈缺损、管腔狭窄.结论:螺旋CT检查对于早期诊断肠系膜上动脉血栓形成是一种有价值的方法.对于不明原因所致腹痛及临床怀疑肠系膜缺血的患者均应及时行螺旋CT检查.     

高频彩超诊断小儿肠系膜淋巴结炎的应用价值

目的探讨儿童急性肠系膜淋巴结炎临床特点和高频彩超诊断的价值。方法对88例诊断为肠系膜淋巴结炎惠儿临床和经腹壁高频彩超（高频探头5—13MHZ）探查结果进行分析。结果急性肠系膜淋巴结炎的超声检查表现为右中下腹及脐旁探及数个大小不等的低回声椭圆形团块,边缘清晰,完整,内部回声均匀,长径与短径之比均〉1．5,长径〉1.0cm,横径〉0.5cm。彩色多普勒血流图（CDFI）表现血流丰富,脉冲多谱勒血流频谱阻力指数（RI）〉0．5。结论临床结合高频彩超能有效诊断肠系膜淋巴结炎。高频彩超准确性高,对肠系膜淋巴结炎诊断直观、安全、方便、重复性好,可为临床提供可靠的诊断依据之一。     

血清生物学指标在急性肠系膜缺血早期诊断中的研究进展

急性肠系膜缺血是临床上较严重的外科急腹症之一,具有较高的病死率,早期诊断较为困难,患者确诊时病情一般已进展到了肠管壁不可逆性坏死,或合并其他脏器损伤.急性肠系膜缺血的症状及体征一般并不具有特异度,通常在剖腹探查手术时才能明确诊断.多层螺旋CT在急性肠系膜缺血诊断上显示了较高的特异度和灵敏度,但是对于非阻塞性肠系膜缺血的...     

肠系膜上动脉压迫综合征的诊断和治疗

目的探讨肠系膜上动脉压迫综合征的病因、诊断和治疗方法。方法对1980年1月至2008年10月我院普外科收治的32例肠系膜上动脉压迫综合征的临床资料进行回顾性分析。结果本组均采用十二指肠空肠Roux-en-Y侧侧吻合加Treitz韧带松解术行手术治疗,术后病人症状均得到缓解,无死亡病例和并发症发生。结论肠系膜上动脉压迫综合征的主要确诊手段为X线钡餐造影;对保守治疗无效可采用手术治疗,十二指肠空肠侧侧Roux-en-Y吻合加Treitz韧带松解术为理想术式。     

Recanalization of Chronic Noncirrhotic,Nonmalignant Splanchnic Thromboses is Feasible: A Transsplenic Assisted Patient-Tailored Approach

The purpose of this study was to evaluate the feasibility of recanalization of chronic noncirrhotic, nonmalignant splanchnic thromboses with a transsplenic assisted patient-tailored approach with or without transjugular intrahepatic portosystemic shunt (TIPS) creation. In this retrospective study, 10 patients (median age, 48.4 years; interquartile range, 5.1 years) underwent revascularization between November 2016 and August 2020. Portal cavernoma was present in all patients, with complete splenic vein thrombosis in 70%. The technical success rate was 80%. Additional TIPS creation was performed in 5 (50%) patients. At a median follow-up of 19.3 months (interquartile range, 17.9 months), the primary and secondary patency rate was 70% and 100%, respectively. During follow-up, 1 patient died due to recurrent upper gastrointestinal variceal hemorrhage. In conclusion, percutaneous transsplenic assisted recanalization of chronic noncirrhotic, nonmalignant splanchnic thromboses is feasible. However, multiple access points may still be needed. Additional TIPS creation appears to be necessary only in case of insufficient portal venous flow into the liver.     

Superior mesenteric artery first approach versus standard pancreaticoduodenectomy:a systematic review and meta-analysis

BACKGROUND: The superior mesenteric artery (SMA) first approach was proposed recently as a new modification of the standard pancreaticoduodenectomy. Increasing evidence showed that a periadventiceal dissection of the SMA with early transection of the inflow during pancreaticoduodenec-tomy associates better early perioperative results, and setup the scene for long-term oncological benefits. The objectives of the current study are to compare the operative results and long-term oncological outcomes of SMA first approach pan-creaticoduodenectomy (SMA-PD) with standard pancreatico-duodenectomy (S-PD).DATA SOURCES: Electronic search of the PubMed/MEDLINE, EMBASE, Web of Science and Cochrane Library was performed until July 2015. We considered randomized controlled trials (RCTs) and non-randomized comparative studies (NRCSs) comparing SMA-PD with S-PD to be eligible if they included patients with periampullary cancers.RESULTS: A total of one RCT and thirteen NRCSs met the in-clusion criteria, involving 640 patients with SMA-PD and 514 patients with S-PD. The SMA-PD was associated with less in-traoperative bleeding, less blood transfusions and higher rate of associated venous resections. The pancreatic fistula and delayed gastric emptying had a significantly lower rate in the SMA-PD group. There were no differences between the two approaches regarding overall complications, major complica-tion rates and in-hospital mortality. There was no difference regarding R0 resection rate, and one-, two- or three-year over-all survival. The SMA-PD was associated with a lower local, hepatic and extrahepatic metastatic rate.CONCLUSIONS: The SMA-PD is associated with better perioperative outcomes, such as blood loss, transfusion re-quirements, pancreatic fistula, and delayed gastric emptying. Although the one-, two- or three-year overall survival rate is not superior, the SMA-PD has a lower local and metastatic re-currence rate.