肠系膜上动脉栓塞临床表现及影像特征研究

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。

Study of Clinical Features and Image Characteristics of Superior Mesenteric Artery Embolism

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 embolismtriad 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.