摘要
目的 回顾性分析多层螺旋CT在肠系膜上动脉病变致缺血性肠病的影像表现,为临床早期诊断提供依据。方法 收集 2012年8月至2015年8月在本院行CT检查并经临床证实的肠缺血患者6例,采用多层螺旋CT进行全腹CT扫描,其中4例 增强扫描。以横断面原始CT图像加多种后处理技术进行肠系膜上动脉成像评价。结果 6例患者中3例急性肠缺血, 临床表现急性腹痛,3例均为肠系膜上动脉血栓,CT增强扫描显示肠系膜上动脉血栓,管腔内充盈缺损,轻度、中 度狭窄,狭窄度介于50%左右。慢性肠缺血3例,表现为与进食有关慢性腹痛,肠系膜上动脉长段或局限性钙化狭 窄。6例中2例发生轻症肠梗阻,肠管积气积液扩张,肠壁增厚模糊。6例患者临床非手术治疗,疗效明显。结论 螺 旋CT可以明确肠系膜上动脉病变致缺血性肠病的早期诊断,对临床治疗具有重要指导意义。
Objective To provide the basis for early diagnosis, imaging of ischemic bowel disease caused by superior mesenteric artery disease was analyzed with multi-slice spiral CT retrospectively. Methods 6 cases of intestinal ischemia from August 2012 to August 2015 in this hospital onfirmed by clinical were collected, multi-slice spiral CT was proceed for a full abdominal CT scan, among of them 4 cases were enhanced scanning. Superior mesenteric artery was evaluated with cross section original CT image and variety processing technology. Results 3 cases of 6 patients were acute intestinal ischemia, with clinical manifestations of acute abdominal pain, and all 3 cases were superior mesenteric arterial thrombosis. CT enhancement scan shows thrombosis of the superior mesenteric artery with intraluminal filling defects. Mild to moderate narrowing were seen, degree of stenosis was between about 50%.The other 3 cases of chronic intestinal ischemia were characterized by chronic abdominal pain associated with eating, with long distance or local calcification stenosis of superior mesenteric artery. 2 cases of 6 occurred in mild cases of intestinal obstruction, with intestinal gas fluid expansion and thickening blur.6 cases of patients with non-surgical treatment have curative effect. Conclusion MSCT can give clear early diagnosis of ischemic bowel disease caused by superior mesenteric arterial lesions, which is important for guiding significance for clinical treatment.
【关键词】螺旋CT;CTA技术;肠系膜上动脉;缺血性肠病;急腹症
【中图分类号】R656.1
【文献标识码】A
【DOI】10.3969/j.issn.1009-3257.2016.02.015
前言
缺血性肠病是因各种原因引起肠壁供血不足导致 缺血、缺氧的一组疾病。在临床上动脉粥样硬化所致 的血管狭窄是引起慢性肠系膜缺血的主要原因,肠系 膜上动脉栓塞或血栓形成是常见的急性肠系膜缺血主 要原因[1],急性缺血性肠病可发生于肠管供血的各级 血管,病情发展迅速,发病凶险,死亡率高,是临床 一种较少见的急腹症,其临床表现隐匿,由于缺乏特 异性的临床表现及体征,此病早期诊断很重要但临床 早期诊断困难[2]。近年来,因螺旋CT广泛应用,在常规检查的同时可以观察血管腔内外的情况,已逐渐取 代有创性数字减影血管造影技术(DSA)对肠系膜缺血 性疾病的诊断,使得肠系膜缺血性疾病的早期诊断准 确率明显提高。本文回顾性分析多层螺旋CT及重建技 术在肠系膜缺血病例中的影像表现,探讨其在该病早 期诊断中的临床价值。
罕少疾病杂志
第23卷, 第 3 期
2019年11月
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