肠系膜上动脉分型与胡桃夹综合征关系的MSCT评价

目的 探讨肠系膜上动脉(SMA)形态与胡桃夹综合征之间的关系.资料与方法 54例肾脏增强扫描患者按SMA形态(A型和B型)分成两组,测量SMA近段与远段的夹角和SMA与从的夹角,并进行统计学分析.结果 两型SMA与腹主动脉(AA)的夹角有统计学差异,同时B型SMA更易发生胡桃夹综合征.结论 MSCT可以很好地评价SMA与胡桃夹综合征之间的关系.     

Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

AIM: To summarize our methods and experience with interventional treatment for symptomatic acute-subacute portal vein and superior mesenteric vein thrombosis (PV-SMV) thrombosis. METHODS: Forty-six patients (30 males, 16 females,aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were accurately diagnosed with Doppler ultrasound scans, computed tomography and magnetic resonance imaging.They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutaneous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization).RESULTS: The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased significantly. Symptoms in these 45 patients were improved dramatically without severe operational complications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment.In 3 patients with interventional treatment, thrombi re-formed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful.CONCLUSION: Interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acutesubacute PV-SMV thrombosis.     

Superior mesenteric artery syndrome in a diabetic patient with acute weight loss

Superior mesenteric artery (SMA) syndrome is an uncommon disease resulting compression of the third portion of the duodenum from the superior mesenteric artery. This disease shares many common manifestations with diabetic gastroparesis, including postprandial fullness, nausea, vomiting, and bloating. Therefore, it is often overlooked in diabetic patients. Here, we report a 41-year-old man with poorly controlled diabetic mellitus who developed SMA syndrome due to rapid weight loss. The diagnosis was confirmed by computed tomography and an upper gastrointestinal series. His condition improved after parenteral nutrient, strict sugar control, and gradual weight gain.     

Congestion of Superior Mesenteric Veins and Small Bowel Mucosal Injury After Endoscopic Treatment of Esophageal Varices in Patients with Portal Hypertension

We investigated treatment-induced changes in venous return from the small bowel and small bowel intestinal mucosal injury induced by the treatment of esophageal varices in patients with portal hypertension. A total of 14 patients (age 59.8 ± 9.5 years, five women and 9 men) who received prophylactic treatment of esophageal varices between December 1998 and March 1999 were investigated. Diamine oxidase (DAO) activity was measured before and after treatment. Changes in blood flow of the portal and superior mesenteric veins were investigated by Doppler ultrasonography in six patients. A significant decrease in DAO activity was observed three days after treatment (11.5 ± 1.6 units/liter prior to treatment versus 8.6 ± 1.6 units/liter three days after treatment; P < 0.001). Decreases in superior mesenteric and portal venous flow velocity were observed in four and three patients, respectively. In two patients with an increase in the cross-sectional area of the superior mesenteric vein with delayed venous return, a marked decrease in DAO activity was observed three days after treatment. In patients with portal hypertension, rapid reduction of pooling of portal flow caused by the treatment of esophageal varices can induce transient congestion of the mesenteric venous system which can produce some small bowel mucosal injury.     

肠系膜下动脉彩色多普勒超声检查的意义

目的研究肠系膜下动脉的检查方法与二维图像及多普勒检查的正常值。方法沿腹主动脉扫查,在脐左上方显示肠系膜下动脉的长轴与短轴,并测量内径及多普勒检查。结果62例成人肠系膜下动脉的内径男性(2.99±0.34)mm,女性(2.76±0.40)mm,收缩期流速男性(1.04±0.29)m/s,女性(0.97±0.28)m/s,RI男性(0.86±0.04),女性(0.84±0.02),PI男性(2.81±0.05),女性(2.76±0.44)。结论彩色多普勒超声能正确评价肠系膜下动脉的正常表现,对进一步研究相关疾病导致血管、血流的变化有参考价值。     

Identification and Characterization of Peripheral Neuronal Dopamine Receptors in the Rat

The effects of local administration of the dopamine receptor agonists apomorphine and pergolide were investigated in the isolated autoperfused hindquarters, renal and superior mesenteric vascular beds of the rat, in order to assess whether presynaptic dopamine receptors in these vascular regions could play a role in the hypotensive effect of these agents. In the three vascular beds, local infusion of apomorphine and pergolide did not influence perfusion pressure per se, but clearly reduced the pressure response to electrical stimulation of the sympathetic innervation. Increases in perfusion pressure induced by local administration of noradrenaline were not influenced by apomorphine and pergolide. The inhibitory effect of apomorphine and pergolide on stimulation-evoked pressure responses was completely antagonized by the dopamine receptor antagonist haloperidol. The α₂-adrenoceptor antagonist rauwolscine, which completely blocked the inhibitory effect of the α₂-adrenoceptor agonist UK-14,304–18 on neurogenic vasoconstriction, had no influence on the inhibitory effect of apomorphine and pergolide. Like haloperidol, the DA₂-receptor antagonist domperidone antagonized the inhibition of neurogenic vasoconstriction by apomorphine in the three vascular beds; the DA₁-receptor antagonist SCH 23390 had no influence. These results indicate that inhibitory DA₂-receptors are present on the sympathetic innervation to the hindquarters, renal and superior mesenteric vascular beds of the rat.     

肠系膜下静脉汇入角度与左半结直肠癌肝转移灶分布规律的关系

［摘要］ 目的 分析肠系膜下静脉（IMV）汇入门静脉系统角度与左半结直肠癌肝转移灶分布的关系。方法 中山大学附属第六医院2012年1月至2017年1月期间收治的113例行全腹部+盆腔CT 检查的左半结直肠癌肝转移患者的影像学资料。根据门静脉系统重建三维图像，将门静脉系统的解剖类型分为IMV汇入门静脉角、IMV汇入肠系膜上静脉（SMV）、IMV汇入脾静脉（SV）3种类型，分析IMV汇入门静脉系统分型和成角情况以及成角与肝转移灶分布关系。结果 全组男性68例，女性45例，平均年龄58.4岁；同时性肝转移93例（82.3%），异时性肝转移20例（17.7%）；其中结肠脾曲癌2例（1.8%），降结肠癌7例（6.2%），乙状结肠癌42例（37.2%），直肠上段癌62例（54.8%）；肝内单发病灶共38例（33.6%），多发病灶共75例（66.4%）。根据三维重建结果将IMV汇入门静脉系统情况分为3型：IMV汇入门静脉角（17例，15.0%），IMV汇入SMV（31例，27.4%），IMV汇入SV（65例，57.6%）。113例左半结直肠癌伴肝转移患者中，IMV汇入门静脉角共17例，IMV与SMV成角>90°患者转移灶100%位于肝左叶，IMV与SMV成角<90°患者转移灶位于肝右叶（20%）和肝左叶（80%），肝转移灶分布构成比的差异有统计学意义（P<0.05）； IMV与SV成角>90°患者转移灶位于肝右叶（25%）、肝左叶（0%）和肝左右叶（75%），IMV与SV成角<90°患者转移灶位于肝右叶（20%）、肝左叶（80%）和肝左右叶（0%），肝转移灶分布构成比的差异有统计学意义（P<0.05）。IMV汇入SMV共31例，IMV与SMV成角>90°患者转移灶位于肝右叶（66.7%）、肝左叶（8.3%）和肝左右叶（25%），IMV与SMV成角<90°患者转移灶位于肝右叶（26.3%）、肝左叶（36.8%）和肝左右叶（36.8%），肝转移灶分布构成比的差异有统计学意义（P<0.05）。IMV汇入SV共65例，IMV与SV成角>90°患者转移灶位于肝右叶（50%）、肝左叶（35.7%）和肝左右叶（14.3%），IMV与SV成角<90°患者转移灶位于肝右叶（21.6%）、肝左叶（25.5%）和肝左右叶（52.9%），肝转移灶分布构成比的差异有统计学意义（P<0.05）。结论 根据IMV汇入方式进行门静脉系统的三类分型中，IMV汇入门静脉系统的角度均与左半结直肠癌肝转移灶分布密切相关，尤其在IMV以成角>90°汇入门静脉系统时，能更好地预测左半结直肠癌肝转移灶分布区域，对于疾病的临床预判、监测和治疗具备相当参考价值。     

Insulin Attenuates Vasoconstriction by Noradrenaline,Serotonin and Potassium Chloride in Rat Mesenteric Arterioles

We investigated the effect of insulin on the vascular reactivity to noradrenaline, serotonin and potassium chloride in rat mesenteric resistance arterioles in vitro. Mesenteric artery segments were placed in a myograph system. Sensitivity to noradrenaline, serotonin and KC1 was tested after an equilibration at 37d`C. Thereafter, arteries were incubated with buffer alone or with insulin (40, 100, 250 and 400 mU/ml) for one hour at 37d`C. Sensitivity to the three vasoconstrictors was retested. Incubation with noradrenaline, serotonin and KC1 resulted in a dose dependent increase in wall force. Exposure with buffer did not change the shape of the dose-response-curve. The same was true for the lowest dose of insulin (40 mU/ml). However, incubation with insulin at concentrations of 100, 250 and 400 mU/ml led to a reduction in wall force by 37-77 %. The reduction in the slope of the curve and the maximal response suggest a non-competitive inhibition. Supraphysiological doses of insulin attenuate the vasoconstriction by noradrenaline, serotonin and KC1 in rat mesenteric arteries in vitro.