肠系膜血管CTA诊断小肠缺血病因的应用价值

目的：探讨肠系膜血管CTA诊断小肠缺血病因的价值。方法：回顾性分析22例小肠缺血患者的肠系膜血管CTA表现，12例为急性缺血，10例为慢性缺血。分析内容包括肠系膜血管有无狭窄、扩张、充盈缺损、聚集、移位。结果：12例急性缺血病人中，肠系膜上动脉栓塞2例，CTA表现为肠系膜上动脉突然中断；肠系膜上动脉血栓形成5例，表现为管腔内充盈缺损；肠系膜上静脉及门静脉血栓3例，表现为管腔内完全性或不全性充盈缺损；肠系膜上动脉夹层2例，表现为真假腔形成及之间的内膜片。10例慢性缺血病人中，粥样硬化性缺血6例，4例CTA表现为肠系膜上动脉不同程度的狭窄，2例表现为肠系膜上动脉起始部闭塞伴Riolan血管弓形成；肠系膜上动脉起始部动脉瘤2例，表现为管腔球形扩张；系统性红斑狼疮性缺血性肠病2例，表现为肠系膜血管增粗、“梳状”排列。结论：肠系膜血管CTA能够明确诊断小肠缺血的病因。

Value of CT angiography of mesenteric vasculature in diagnosing the etiology of small bowel ischemia

Objective： To investigate the value of CT angiography（CTA） of mesenterie vaseulature in diagnosing small bowel isehemia. Methods： CTA findings of mesenterie vaseulature in 22 patients with small bowel isehemia were reviewed retrospectively. Twelve patients were classified as acute small bowel isehemia and other 10 as chronic. Analysis included presence or absence of stenosis, dilation, intraluminal filling defect, convergence, and displacement of mesenterie vaseulature. Results： Of the 12 patients with acute small bowel isehemia, abrupt termination of superior mesenterie artery（SMA） was seen in 2 with SMA embolus, intraluminal filling defect seen in 5 with SMA thrombosis and 3 with mesenterie and portal venous thrombosis, formation of true and false lumen in 2 cases with dissection of SMA. Of the 10 patients with chronic small bowel isehemia, stenosis of SMA was seen in 4 of the 6 cases with atheroselerotie mesenterie ischemia, and occlusion of SMA complicated with Riolan＇s arch seen in the other 2, dilation of proximal SMA in 2 cases of aneurysm of SMA, dilation and eomblike pattern seen in 2 cases with systemic lupus erythematosis. Conclusion： Etiology of small bowel isehemia can be confirmed with CTA of mesenterie vasculature.