急性肠系膜上动脉血栓栓塞的早期影像诊断及介入治疗(附5例报告)

Early Imaging Diagnosis and Interventional Therapy of Acute Superior Mesenteric Artery Thrombotic Embolism(5 Cases Report)

目的探讨肠系膜上动脉(SMA)血栓早期诊断及急诊置管溶栓介入治疗的应用价值。方法回顾分析2009年10月至2011年11月5例在本院就诊并行介入置管溶栓的SMA血栓患者的临床资料,分析总结其临床表现、影像特征及介入置管溶栓治疗的方法与疗效,以探讨介入置管溶栓治疗的应用价值。结果 5例患者均行CTA检查,显示SMA低密度充盈缺损,提示血栓形成;5例溶栓治疗效果满意,其中4例患者腹痛消失,1例腹痛缓解,无肠坏死的表现,1周后复查造影其中4例见SMA主干及分支基本开放,1例SMA主干局部充盈缺损缩小,远端分支部分显影。结论可疑SMA血栓形成的患者,及时早期行CTA明确诊断,急诊介入置管溶栓是一种有效的治疗方法。

Objective To discuss the value of early imaging diagnosis and endovascular intervention thrombolytic therapy in patients with embofic or thrombotic occlusion of the superior mesenteric artery （SMA）. Methods The clinical data of 5 patients who suffered from SMA thrombosis with endovascular intervention thrombolytic therapy were reviewed retrospectively in our hospital from Oct 2009 to Nov 2011. The clinical manifestation, imaging features, efficacy of endovascular thrombolytic therapy were summarized and the clinical value of endovascular intervention thrombolytic therapy was discussed. Results Five patients underwent CTA and showed hypodensity filling defect of SMA indicating thrombosis. All of them obtained satisfactory effect, abdominal pain vanished in 4 patients and alleviation in 1 patient, none of them showed intestinal necrosis, five patients were rechecked by angiography after 1 week, main trunk of SMA and its branches of 4 patients became open basically, another patient showed that filling defect was reduced in the main trunk of SMA and its branches got better after treatment. Conclusion Patients with potential embolic or thrombotic occlusion of the SMA should receive CTA as soon as possible to make diagnosis, early endovascular thrombolytic therapy is an effective treatment method.