| 王科鑫,陈月芹,魏君臣,王培洁,张庆鑫,姜鑫.肠系膜上动脉病变临床表现及256层iCT对其诊断价值研究[J].济宁医学院学报,2020,43(2):113-117 |
| 肠系膜上动脉病变临床表现及256层iCT对其诊断价值研究 |
| Clinical manifestation and diagnostic value of 256-slice iCT for superior mesenteric artery lesions |
| 投稿时间：2019-12-30 |
| DOI：10.3969/j.issn.1000-9760.2020.02.010 |
| 中文关键词: 肠系膜上动脉病变;256层iCT;血管成像;临床表现 |
| 英文关键词: Superior mesenteric artery lesion;256 Slice iCT;Angiography;Clinical manifestation |
| 基金项目: |
| 作者 | 单位 | E-mail | | 王科鑫 | 济宁医学院附属医院, 济宁 272029 | | | 陈月芹 | 济宁医学院附属医院, 济宁 272029 | | | 魏君臣 | 济宁医学院附属医院, 济宁 272029 | | | 王培洁 | 济宁医学院附属医院, 济宁 272029 | | | 张庆鑫 | 济宁医学院附属医院, 济宁 272029 | | | 姜鑫 | 济宁医学院附属医院, 济宁 272029 | jx0929@qq.com |
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| 中文摘要: |
| 目的 探讨肠系膜上动脉(superior mesenteric artery, SMA)病变临床表现及256层iCT对该病变的诊断意义。方法 收集我院2016年10月至2018年6月临床怀疑SMA病变患者80例。所有患者均行Philips Brilliance 256层iCT全腹部CTA检查,在Portal后处理工作站,通过容积再现(volume rendering,VR)、曲面重建(curved multiplanar reformations,CMPR)、最大密度投影(maximum intensity projection,MIP)重建方法进行影像研究,结合临床资料对其临床表现进行总结和分析。结果 80例怀疑SMA病变患者最终临床诊断为SMA病变65例,其中SMA缺血性病变患者44例(SMA管腔主干低密度充盈缺损血栓性栓塞25例,SMA粥样硬化斑块形成、管腔狭窄19例);SMA夹层(superior mesenteric artery dissection,SMAD)患者19例(孤立性SMAD 2例,腹主动脉夹层累及SMAD 17例);SMA及其分支、部分肠管扭转呈漩涡状改变患者2例。所有SMA急性栓塞患者突发腹痛(25/25,100%),腹痛恶心呕吐(14/25,56%),肠鸣音活跃(16/25,64%),持续疼痛伴腹胀(19/25,76%),腹壁压痛、反跳痛(11/25,44%),腹泻伴有便血(8/25,32%)。SMAD症状复杂多样,突发腹痛(19/19,100%),持续性疼痛(14/19,73.7%),进行性加重(11/19,57.9%)。SMA及部分肠管扭转主要表现为:1)脐周持续性疼痛伴呕吐、腹胀;2)背部疼痛,进行性腹胀加重。256层iCT对SMA病变诊断敏感度92.31%,特异度80%,诊断准确率90%。结论 SMA病变临床表现无特异性,但256层iCT及相应后处理技术可从多角度、多方位清晰显示SMA病变,确定病变性质,为临床提供丰富的诊断依据。 |
| 英文摘要: |
| Objective To explore clinical features and diagnostic value of superior mesenteric artery lesion by 256 slice iCT.Methods 80 patients were collected with clinically suspected superior mesenteric artery disease from October 2016 to June 2018.All patients were examined CTA of whole abdomen by 256 slice iCT.In the portal post-processing workstation,image analysis was carried out by volume rendering(VR),surface reconstruction(CPR)and maximum density projection(MIP)combined with clinical data to summarize and analyze the clinical manifestations.Results 65 cases of SMA were confirmed by clinic diagnosis.Patients with superior mesenteric artery ischemic disease were 44 cases,(thromboembolic embolization of SMA lumen were 25 cases;SMA atheromatous plaque formation and lumen narrow were 19 cases).Patients with superior mesenteric artery dissection were 19 cases,(patients with isolated superior mesenteric artery lesions were 2 cases;patients with abdominal aortic dissection involving superior mesenteric artery dissection were 17 cases).Two cases appeared spiral changes of the superior mesenteric artery in its branches and part of the intestine.All patients with acute embolism of superior mesenteric artery showed abdominal pain(25/25,100%),nausea and vomiting(14/25,56%),active bowel sounds(16/25,64%),persistent colic with abdominal distention(19/25,76%),abdominal pressure pain and rebound pain(11/25,44%),diarrhea and hematochezia(8/25,32%).SMA chronic ischemia could cause serious clinical symptoms.The clinical symptoms of superior mesenteric artery dissection were complex and diverse.The main manifestation was sudden abdominal pain(19/19,100%),persistent pain(14/19,73.7%),progressive aggravation(11/19,57.9%).The clinical symptoms of superior mesenteric artery and partial bowel torsion were:perichilum persistent pain associated with vomiting and abdominal distention,back pain and progressive abdominal distention.The sensitivity of 256 slice iCT for superior mesenteric artery disease was 92.31%;the specificity was 80%,and the accuracy was 90%.Conclusion The 256-slice iCT and Portal post processing technology could clearly display the superior mesenteric artery disease from multiple angles and directions to determine the nature of the disease with diagnostic accuracy up to 90%,which provide abundant diagnostic basis for clinical practice. |
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