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。
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 embolism triad 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.
出处
《现代生物医学进展》
CAS
2014年第36期7100-7104,共5页
Progress in Modern Biomedicine
关键词
肠系膜上动脉
栓塞
血管造影
体层摄影
Superior mesenteric artery
Embolism
Angiography
Computed tomography
