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目的:总结急性肠系膜缺血(AMI)的临床资料及CT影像特征并探讨多层螺旋CT(multi-slice spiral computed tomography,MSCT)对该病的诊断价值。方法:回顾性分析经临床或手术证实的54例AMI患者的CT和临床资料,包括其发病时间、主要症状、体征、相关实验室检查指标,评价并分析异常的MSCT表现。结果:54例均以非特异性腹痛为首发症状,其中肠系膜上静脉血栓形成(SMVT)38例,肠系膜上动脉栓塞(SMAE)12例,肠系膜上动脉血栓形成(SMAT)4例。MSCT诊断AMI的直接征象为血管内充盈缺损(43例),间接征象包括:肠壁增厚35例,“靶征”16例,肠管扩张20例,“缆绳征”22例,肠壁积气征13例,“薄壁样征”12例,腹腔积液34例。结论:AMI的临床表现缺乏特异性,MSCT检查可准确诊断AMI并明确缺血程度、范围,对指导治疗具有较高的应用价值。
OBJECTIVE: To summarize the clinical data of acute mesenteric ischemia (AMI) and the features of CT images and investigate the diagnostic value of MSCT in the diagnosis of this disease. Methods: CT and clinical data of 54 patients with AMI confirmed clinically or surgically were retrospectively analyzed, including the time of onset, the main symptoms and signs, the related laboratory tests, and the evaluation and analysis of abnormal MSCT findings. Results: All of the 54 patients had nonspecific abdominal pain as the first symptom, including 38 cases of superior mesenteric vein thrombosis (SMVT), 12 cases of superior mesenteric artery embolization (SMAE) and 4 cases of superior mesenteric artery thrombosis (SMAT). The direct signs of AMI diagnosis of MSI were intravascular filling defect (43 cases). The indirect signs included: 35 cases of intestinal wall thickening, 16 cases of “target sign”, 20 cases of bowel dilatation, 22 cases of “cable sign” 13 cases of intestinal wall gas accumulation, “thin-wall signs ” in 12 cases, 34 cases of ascites. Conclusion: The clinical manifestations of AMI lack of specificity, MSCT can accurately diagnose AMI and clear the extent of ischemia, the scope of guidance and treatment has a high value.