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目的探讨急性肠系膜上动脉缺血的早期诊断及数字减影血管造影(DSA)介入治疗价值。方法 8例经增强CT诊断为急性肠系膜上动脉缺血患者,经右侧股动脉穿刺插管,行肠系膜上动脉造影,3例肠系膜上动脉夹层动脉瘤放置支架,3例肠系膜上动脉栓塞及2例肠系膜上动脉血栓采取溶栓、取栓、扩血管及支架植入,术后常规给阿司匹林、氯吡格雷抗凝。比较DSA治疗前后腹痛、血管再通情况。结果 3例肠系膜上动脉夹层动脉瘤放置支架后血管再通,腹痛消失,1例急性肠系膜上动脉栓塞溶栓、取栓及扩血管治疗后腹痛缓解、血管再通,1例急性肠系膜上动脉血栓溶栓后放置支架。3例转外科手术。随访半年以上,5例DSA治疗后血管再通患者恢复良好,无并发症发生。结论增强CT可作为早期诊断急性肠系膜上动脉缺血的首选方法,DSA是诊断和治疗部分早期肠系膜上动脉缺血的有效手段。
Objective To investigate the early diagnosis of acute superior mesenteric artery ischemia and the value of digital subtraction angiography (DSA) interventional therapy. Methods Eight patients with acute superior mesenteric artery disease were diagnosed by enhanced CT. The superior mesenteric artery was punctured and inserted into the superior mesenteric artery. Three patients with superior mesenteric artery dissection, three patients with superior mesenteric artery embolization and two Cases of superior mesenteric artery thrombosis thrombolysis, thrombectomy, vasodilator and stent implantation, postoperative routine to aspirin, clopidogrel anticoagulation. Before and after DSA treatment of abdominal pain, recanalization situation. Results 3 cases of superior mesenteric artery dissecting aneurysm after stent placement recanalization, abdominal pain disappeared, 1 case of acute superior mesenteric artery thrombolysis thrombolysis, thrombectomy and vasodilation after abdominal pain relief, recanalization, 1 case of acute superior mesenteric artery thrombosis Place the stent after thrombolysis. 3 cases transferred to surgery. Follow-up more than six months, 5 cases of DSA after treatment of patients with recanalization recovered well, no complications. Conclusion Enhanced CT can be used as the first choice for early diagnosis of acute superior mesenteric artery ischemia. DSA is an effective method to diagnose and treat some of the early superior mesenteric artery ischemia.