急性肠系膜缺血27例的临床特点及影像学表现分析

Clinical Features and Imaging Findings of 27 Cases of Acute Mesenteric Ischemia

目的探讨急性肠系膜缺血的临床特点及CT血管造影(CTA)表现。方法对27例急性肠系膜缺血患者临床资料进行回顾分析,统计其临床特点分布情况,并解析CTA影像特征。结果所有患者均伴有腹胀或腹痛,其余伴随症状则以恶心、呕吐、纳差、腹膜刺激征、消化道出血、便血、肠鸣音减弱或消失为主;病史主要包括腹部外科手术史、高血压病、房颤、冠心病等,实验室检查结果则以血浆D-二聚体、胆红素、转氨酶、乳酸脱氢酶、血白细胞计数增加及血浆血红蛋白减少为主;其中治疗无效死亡3例(11.11%)。CTA下直接征象主要包括肠系膜动静脉充盈缺损、管壁增厚或毛糙,少数可见肠系膜血管壁钙化斑块或结节;间接征象可观察到受累肠管、肠管扩张伴或不伴有气液平、腹腔积气或积液、肠壁环形增厚及肠壁异常强化,少数可见肠壁积气与门静脉积气。结论急性肠系膜缺血临床特点不甚典型,但其CTA征象直观且确切,对其早期诊治意义重大。

Objective To explore the clinical features of acute mesenteric ischemia and CT angiography(CTA) findings. Methods The clinical data of 27 patients with acute mesenteric ischemia were retrospectively analyzed. The distribution of clinical features was analyzed, and the CTA imaging features were analyzed. Results All patients were accompanied by bloating or abdominal pain, and the remaining accompanying symptoms were mainly nausea, vomiting, poor appetite, peritoneal irritation sign, gastrointestinal bleeding, hematochezia and weakened or disappeared bowel sounds. The history mainly included the histories of abdominal surgery, hypertension diseases, atrial fibrillation and coronary heart disease, and laboratory test results were mainly plasma D-dimer, bilirubin,transaminase, lactate dehydrogenase, increased white blood cell count and reduced plasma hemoglobin. 3 patients died of treatment failure(11.11%). The direct signs of CTA mainly included mesenteric arteriovenous filling defects, wall thickening or roughening and a few visible mesenteric vessel wall calcification plaques or nodules. The indirect signs could observe the involved intestine, dilatation of intestine with or without gas liquid level,abdominal gas or effusion, annular thickening of intestine wall and abnormal enhancement of intestinal wall, a few visible pneumatosis intestinalis and portal venous gas. Conclusion The clinical features of acute mesenteric ischemia are not typical, but its CTA signs are intuitive and accurate, and are of great significance for early diagnosis and treatment of mesenteric ischemia.