急性肠系膜缺血的DSA诊断和经皮血管内治疗的临床价值探讨

目的:探讨急性肠系膜缺血的DSA诊断价值和经皮血管内治疗的临床应用价值。方法:12例临床疑诊患者,均经皮行右侧股动脉穿刺、插管,依次进行升主动脉、腹主动脉、腹腔干和肠系膜上、下动脉造影。其中8被诊断为急性肠系膜缺血,急性肠系膜上动脉栓塞4例;急性肠系膜上动脉血栓形成3例,非闭塞性肠系膜缺血1例。对4例肠系膜上动脉栓塞患者经导管注入溶栓剂(尿激霉)和血管扩张剂(罂粟碱)治疗,2例治疗后血管开通;另2例因症状缓解不明显行外科手术治疗;3例病程较长者造影后直接转外科进行手术治疗。结果:DSA诊断急性肠系膜上动脉栓塞4例。造影表现为肠系膜上动脉主干远端(中结肠动脉起始部)或分支的突然截断(截断征)或管腔内局限性充盈缺损(不完全栓塞)。急性肠系膜上动脉血栓3例,造影表现为肠系膜上动脉起始部的狭窄。1例造影表现为肠系膜上动脉分支弥漫性痉挛(腊肠征)诊断为非闭塞性肠系膜动脉缺血,手术证实为急性肠系膜静脉血栓形成。手术后1周因再次肠坏死而死亡。1例广泛血栓形成患者于造影后6h死亡。另2例肠系膜上动脉血栓患者手术后2周死亡。结论:DSA是诊断各型急性肠系膜缺血的有效手段,可以明确病变的部位和范围,为手术治疗提供定位信息。对急性肠系膜静脉血栓的诊断有一定的局限性。经导管溶栓术是治疗肠系膜动脉栓塞的有效手段。亦可作为外科手术前的辅助治疗手段,减少死亡率。

The clinical value of DSA diagnosis and endovascular treatment for acute mesenteric ischemia

Objective：To approach the value of DSA for diagnosing acute mesenteric ischemia and of endovascular therapy for it.Methods：12 cases suspected were taken the right femoral arteriopuncture,accepting the ascending aorta angiography,abdominal aorta angiography,superior mesenteric artery angiography and inferior mesenteric artery angiography in order.Eight patients were diagnosed for acute mesenteric ischemia including 4 cases of acute superior mesenteric artery embolus,3 cases of acute superior mesenteric artery thrombosis and one case of nonocclusive mesenteric vasoconstriction.Four patients encountered for acute superior mesenteric artery embolus were undergone the transcatheter thrombolysis（urokinase） and vasodilatation（cardoverine）.Arterial recanalization was seen in two patients.The other two patients were carried out surgical operation for not obvious symptomatic relief.Two patients were directly undergone operation for long course after identified by DSA.Results：Acute superior mesenteric artery emboli were diagnosed in four patients by DSA and displayed the abrupt termination of superior mesenteric artery bole or branch distal to origin of middle colic artery（cutoff sign） or the filling defects in the vessel lumen（nonocclusive embolus）.Acute superior mesenteric artery thrombosis diagnosed in three patients visualized as stenosis of the onset of the superior mesenteric artery.Diffuse spasm of superior mesenteric arterial branches（sausage sign） seen in one patient was diagnosed for nonocclusive mesenteric vasoconstriction,but which was demonstrated as superior mesenteric venous thrombosis by surgical operation.The patient was dead for bowel necrosis again one week after operation.One patient encountered for extensive thrombosis died six hours after angiography.Another two patients for superior mesenteric artery thrombosis died two weeks after operation.Conclusion：DSA is an effective means for diagnosis of all types of mesenteric artery ischemia,which can identify the position and extension of the lesion and give the location for operation.DSA has some shortage in diagnosis of superior mesenteric venous thrombosis.Endovascular treatment is effective for acute mesenteric artery ischemia and can be as an adjunctive therapy before operation to decrease the ratio of death.