| 靳明旭 张娣 马跃虎 苏浩波 殷信道 顾建平.肠系膜上动脉栓塞临床表现及影像特征研究[J].现代生物医学进展英文版,2014,14(36):7100-7104. |
| 肠系膜上动脉栓塞临床表现及影像特征研究 |
| Study of Clinical Features and Image Characteristics of Superior MesentericArtery Embolism |
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| DOI： |
| 中文关键词: 肠系膜上动脉 栓塞 血管造影 体层摄影 |
| 英文关键词: Superior mesenteric artery Embolism Angiography Computed tomography |
| 基金项目: |
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| 中文摘要: |
| 目的：探讨肠系膜上动脉栓塞(superior mesenteric artery embolism，SMA embolism)临床及影像特征，以及时准确诊断从而改
善病人预后。方法：搜集我院2011 年7 月至2014 年8 月临床诊断为SMA 栓塞的患者24 例，回顾性分析其临床及影像资料。结
果：24 例SMA 栓塞发病年龄51~84 岁，平均71.9± 8.1 岁；临床均表现为突发腹痛（24/24，100 %），腹痛多持续不缓解（18/24，75
%），少有放射痛（1/24，4.17 %），多伴有恶心呕吐（16/24，66.67 %）、腹泻便血（15/24，62.5 %），体格检查多有肠鸣音亢进
（19/24，79.17 %），少有腹膜刺激征（2/24，8.33 %）。多合并高血压（18/24，75 %）、房颤（16/24，66.67 %）、冠心病（14/24，58.33 %）、心
脏瓣膜病变（6/24，25 %）及其他周围动脉栓塞（9/24，37.5 %）。临床上符合SMA 栓塞三联征中至少两项特征20例（83.33%），具备
典型三联征13 例（54.17%）。MSCTA 或DSA 均表现为SMA 主干截断或充盈缺损（24/24，100 %），栓塞位置多位于第1空肠动脉
起始至回结肠动脉起始水平段（18/24，75 %），栓塞远端分支血管多显影不良（23/24，95.83 %），少有侧枝循环形成（3/24，12.5 %）。
MSCTA 显示栓塞段血管密度多有增高（12/17，70.59 %），少有管径增粗（3/17，17.65 %）及脂肪间隙模糊（2/17，11.76 %）。肠管多有
缺血改变（15/17，88.24 %），肠系膜多增粗模糊（15/17，88.24 %），腹水少见（1/17，5.82 %）。结论：SMA 栓塞临床和影像具有一定的
特征性，临床怀疑SMA 栓塞应及早行MSCTA 或DSA 明确诊断。 |
| 英文摘要: |
| Objective:To study the clinical and image features of superior mesenteric artery embolism (SMA embolism), in order
to provide timely diagnosis and improve its prognosis.Methods:The clinical and image date of 24 patients treated from July 2011 to
August 2014 were retrospectively reviewed.Results:All cases were complaint of sudden abdominal pain, more were lasting and no
remission (18/24, 75 %), less was pain radiation (1/24, 4.17 %), more accompanied by nausea and vomiting (16/24, 66.67 %), diarrhea
and hematochezia (15/24, 62.5 %). Hyperactive bowel sounds were usually detected in physical examination (19/24, 79.17 %), and few
peritoneal irritation were shown (2/24, 8.33 %). Many patients complicated with hypertension (18/24, 75 %), atrial fibrillation (16/24,
66.67 %), coronary heart disease (14/24, 58.33 %), valvular heart disease (6/24, 25 %) and other peripheral arterial embolism (9/24, 37.5
%). Clinical conforms to the SMA embolismtriad in at least two features in 20 cases (83.33 %), including 13 cases of typical triad (54.17
%). All cases presented truncation or filling defect sign in MSCTA or DSA image (24/24, 100 %), embolism frequently located in first
jejunal artery to ileocolic artery horizontal segment (18/24, 75 %). Distal vessels and branches were usually not developed or developing
sparse (23/24, 95.83 %), and few collateral circulation were shown (3/24, 12.5 %). MSCTA displayed relative density increasing (12/17,
70.59 %), less diameter enlarge (3/17, 17.65 %), fat interval fuzzy (2/17, 11.76 %) of embolism vascular segments. Different levels of
intestinal ischemia were usually detected (15/17, 88.24 %), as well as mesenteric fuzzy or limitation effusion (15/17, 88.24 %), but few
ascites (1/17, 5.82 %).Conclusion:SMA embolism has certain characteristics in clinical and imaging, and MSCTA or DSA should be
applied for the early diagnosis of SMA embolism. |
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