肠系膜血管病的彩色多普勒超声诊断

分析14例经临床及手术证实的肠系膜血管病的超声表现。直接征象:发生病变肠管壁局限性增厚,局部肠腔缩窄伴蠕动消失,彩色多普勒可观察到部分病因征象,可检查出肠系膜上动脉栓塞,肠系膜上静脉及门静脉的血栓,肠系膜血管闭塞。间接征象:病变周围肠管扩张伴积液积气,并可见肠蠕动和腔内气液流动、腹腔积液、血性腹水等。研究证明彩色多普勒超声是该病的首选方法。

肠系膜血管病采用超声诊断的价值

目的:研究、观察在肠系膜血管病变的诊断中多普勒超声的效果。方法:收治原因不明的疑似急性肠系膜血管缺血性疾病的患者31例,对其进行急诊超声和开腹探查,将两者结果进行对比分析。结果:31例患者中超声检查阳性者26例,5例阴性,其中经开腹探查3例假阳性,2例假阴性,检查的敏感度92%,特异度50%,诊断符合率83.9%,Kappa值80.4%,说明两者有很高的一致率。结论:多普勒超声在肠系膜血管病变的诊断中有较高的准确率,可以作为该病首选的快速、有效的检查手段。

肠系膜血管病的超声诊断

目的 应用彩色多普勒超声诊断肠系膜血管病 ,并总结其声像图特征。方法 18例腹痛患者急诊行超声检查 ,应用高频探头测量小肠壁的厚度、病变范围、肠壁回声、肠蠕动状况、肠壁和肠系膜血流等。结果 肠系膜血管病 18例中 ,超声诊断动脉性缺血 14例 ,超声诊断符合率 85 .7% (12 / 14 ) ;静脉性缺血 4例 ,超声诊断符合率 75 .0 % (3 / 4)。全部病例经手术证实 ,超声诊断符合率 83 .3 % (15 / 18) ,假阳性 2例 (11.1% ) ,假阴性 1例(5 .6% )。结论 超声检查可通过直接征象确定该病的诊断 ,并可判断肠系膜血管栓塞的类别、范围 ,是肠系膜血管病首选的检查方法。

急性肠系膜血管病引起的急腹症6例

急性肠系膜血管血栓或栓塞所致的急腹症在临床上少见,但近年来随着中国人口老龄化,该病的发生率也在增高,该病病情凶险,进展迅速,如不及时得到正确的治疗,预后较差。笔者将我院2010年1月至2013年8月共收治此类病人6例,报告如下。1临床资料本组6例,男4例,女2例,年龄34-85岁。所有患者均因急性腹痛入院,其中既往有脾切除病史3例,

缺血性肠病22例临床分析

目的 探讨缺血性肠病的诊治要点。 方法 回顾分析 2 0 0 1年 3月至 2 0 0 2年 5月 2 2例缺血性肠病的临床资料。 结果 17例结肠缺血通过结肠镜或B超 4 8小时内确诊 (1例行血管造影确诊 ) ,另 5例小肠缺血中 3例在 4 8小时内行选择性血管造影检查而确诊 ,2例通过B超、胃肠X线及内镜在 10天内拟诊。 18例使用罂粟碱及丹参治疗后缓解 ,4例经手术治疗后痊愈或缓解。 结论 缺血性肠病的症状无特异性 ,腹部B超是早期诊断的主要手段 ,应早期进行扩血管治疗。

Etiology and consequences of thrombosis in abdominal vessels

The thrombophilia which can be either congenital or acquired in adult life has major implications in the abdominal vessels. The resulting portal vein thrombosis, Budd-Chiari syndrome and mesenteric vein thrombosis have a variety of consequences ranging from acute abdomen to chronic hepatomegaly and even totally asymp- tomatic patient in whom the only finding is pancytopenia. The complications like esophageal varices, portal gastropathy, ascites, severe hypersplenism, liver failure requiring liver transplantation are well known. Interesting features of collateral venous circulation showing itself as pseudocholangiocarcinoma sign and its possible clinical reflection as cholestasis are also known from a long time. The management strategies for these complications of intraabdominal vessel thrombosis are not different from their counterpart which is cirrhotic portal hypertension, but the prognosis is unquestionably better in former cases. In this review we presented and discussed the abdominal venous thrombosis, etiology and the resulting clinical pictures. There are controversial issues both in nomenclature, and management including anticoagulation problems and follow up strategies. In light of the current knowledge, we discussed some controversial issues in literature and presented our experience and our proposals about this group of patients.

Transhepatic fibrinolysis of mesenteric and portal vein thrombosis in a patient with uIterative colitis: A case report

AIM: To present a case of acute mesenteric and portal vein thrombosis treated with thrombolytic therapy in a patient with ulcerative colitis in acute phase and to review the literature on thrombolytic therapy of mesenteric-portal system. Treatment of acute portal vein thrombosis has ranged from conservative treatment with thrombolysis and anticoagulation therapy to surgical treatment with thrombectomy and/or intestinal resection.METHODS: We treated our patient with intraportal infusion of plasminogen activator and then heparin through a percutaneous transhepatic catheter.RESULTS: Thrombus resolved despite premature interruption of the thrombolytic treatment for neurological complications, which subsequently resolved.CONCLUSION: Conservative management with plasminogen activator, could be considered as a good treatment for patients with acute porto-mesenteric thrombosis.

Preoperative assessment of vascular anatomy of inferior mesenteric artery by volume-rendered 3D-CT for laparoscopic lymph node dissection with left colic artery preservation in lower sigmoid and rectal cancer

AIM： To determine the distance between the branching point of the left colic artery （LCA） and the inferior mesenteric artery （IMA） by computed tomography （CT） scanning, for preoperative evaluation before laparoscopic colorectal operation. METHODS： From February 2004 to May 2005, 100 patients （63 men, 37 women） underwent angiography performed with a 16-scanner multi-detector row CT unit （Toshiba, Aquilion 16）. All images were analyzed on a workstation （AZE Ltd, Virtual Place Advance 300）. The distance from the root of the IMA to the bifurcation of the LCA was measured by curved multi-planar reconstruction on a workstation. RESULTS： The IMA could be visualized in all the cases, but the LCA was missing in two patients. The mean distance from the root of the IMA to the root of the LCA was 42.0 mm （range, 23.2-75.0 mm）. There were no differences in gender, arterial branching types, body weight, height, and body mass index. CONCLUSION： Volume-rendered 3D-CT is helpful to assess the vascular branching anatomy for laparoscopic surgery.

Anaplastic carcinoma of pancreas:report of 6 cases and literature review

Objective:To investigate clinicopathological features,diagnosis and treatment of anaplastic carcinoma of the pancreas and to review relevant literature on this entity. Methods:A retrospective clinical analysis was made in 6 cases of anaplastic pancreatic carcinomas admitted from 1989 to 2001. Results:Anaplastic pancreatic carcinoma was found in 5 men and 1 woman with a mean age of 61.5 years.Tumor location was in the head of the pancreas in 3 patients,body and tail in 3 cases.Tumors were surgically resected in all patients,by pancreaticoduodenectomy in 1,by pancreaticoduodenectomy combined resection and reconstruction of superior mesenteric vein(SMV) in 1,by pancreaticoduodenectomy combined resection and reconstruction of SMV and superior mesenteric artery(SMA) in 1,by distal pancreatectomy in 2,by distal pancreatectomy combined total gastrotectomy in 1.Liver metastasis was found in one patient.Follow-up suggested the prognosis was poor with a mean survival of 5.5 months after operation.All patients were dead with tumor recurrence and liver metastasis. Conclusion:Histologically,anaplastic pancreatic carcinoma is characterized by pleomorphic cell carcinoma consisting of pleomorphic giant/small cells and spindle cells,or osteoclast-like giant cell tumor composed of pleomorphic small cells,or pleomorphic giant cell carcinoma with osteoclastoid giant cells,and demonstrates aggressive biological behavior.Invasions to adjoined organ and metastasis are usual.The prognosis of this tumor appears to be very poor.

Assessment of duodenal circular drainage operations to treat superior mesenteric artery syndrome

Objective To assess the clinical value of duodenal circular drainage operation to treat superior mesenterie artery syndrome（SMAS）. Methods Forty two cases of SMAS were treated with duodenal circular drainage operation from 1959 to 2001. Clinical data were analyzed retrospectively. Results In this group, 37 cases were treated with duodenal circular drainage operation,and had good effect after follow- up of 1-15 years, the other 5 cases were first treated with anterior repositioning of the duodenum （ 1 case）, gastroieiunostomy （ 1 case）, duodeojejunostomy （2 cases）, subtotal gastrectomy and Billroth 11 gastrojejunostomy（1 case） ,but vomiting was not relieved until duodenal circular drainage operation was performed again. Follow - up of 9- 10 years revealed good effect. Conclusion In SMAS, if the reversed peristalsis is stronger and continuous, and vomiting appears frequently, the symptom can not be relieved even if the obstruction of duodenum is removed by operation. The key treatment is the relief of reversed peristalsis. Only the duodenal circular drainage operation could resolve the drainage direction of duodenal content and relieve the symptom of vomiting.

急性肠系膜缺血的诊治进展

缺血性肠病也称肠系膜血管病，是由于各种原因引起的肠急性或慢性血流灌注不良所致的肠壁缺血性疾病。近年来随着社会人口的日益老龄化，动脉硬化所致的疾病发病率增加，缺血性肠病的患病率也有所增加。本病临床表现不典型，误诊率高、并发症多，病死率可高达60％～100％，是临床上严重的急腹症之一，应引起临床医师的关注。从临床特征方面来讲，缺血性肠病主要分为以下3大类型：

肠系膜上动脉影像学检查及进展

缺血性肠病又称为肠系膜血管病，是由于各种不同因素引起的肠急性或者慢性血流灌注不良所致的肠壁缺血性疾病，临床上表现为血运性肠梗阻。缺血性肠病包括急性肠系膜缺血、慢性肠系膜缺血及结肠缺血。

血管外科专家汪忠镐

汪忠镐教授1961年毕业于上海医科大学医疗系。1961～1986年在北京协和医院外科工作,1986至1992年在北京安贞医院血管外科工作,现任邮电总医院血管外科研究所所长,北京医科大学外科学教授。曾先后于1979年9月～1981年9月在美国Duke大学、北卡罗来纳大学和加州大学做访问学者,1991年5～10月在美国弗吉尼亚大学(客座教授身份)进行血管外科和肝移植研究工作。

解读缺血性结肠炎

缺血性结肠炎是供应结肠的小血管因多种原因造成血液灌注不足引起的结肠缺血性损伤，是缺血性肠病（亦称缺血性肠系膜血管病）中最多见的一种。一旦延误诊断，严重者可以导致结肠坏死，危及生命。因此，了解、认识本病，很有必要。