摘要
急性肠系膜缺血(acute mesenteric ischemia,AMI)起病急骤、隐匿,容易导致早期误诊和漏诊,病死率高。重视AMI的早期诊断是挽救缺血肠道和改善预后的关键。了解AMI的病因有助于辨别其临床表现和影像学特点。对于急腹症病人,应根据其症状、体征及动态变化,尽早判断病因,在鉴别诊断时谨记AMI存在的可能,并尽快行影像学检查明确诊断。多层螺旋CT已逐渐成为AMI的一线诊断工具,而肠系膜血管造影依然是AMI诊断的金标准,它不仅可显示病变血管的形态,还可同时行血管内治疗。只要熟悉AMI的常见病因,从并不典型的临床表现中梳理出有价值的线索,将AMI纳入可疑诊断和鉴别诊断列表当中,及时安排快速且有效的影像学检查,将可最大限度地缩短AMI的诊断时间,为挽救缺血肠道赢得宝贵的治疗时间。
Acute mesenteric ischemia （AMI） is characterized by rapid and occult onset，and easily leads to misdiagnosis and missed diagnosis，causing high mortality. Emphasis on early diagnosis of AMI is the key to save ischemic intestine and improve prognosis. Understanding the causes of AMI helps to identify its clinical manifestations and imaging features. For patients with acute abdomen，the cause should be determined based on the symptoms，signs and dynamic changes as early as possible. The differential diagnosis of AMI should be kept in mind and imaging tests should be performed as soon as possible. Multislice spiral CT has become a first-line diagnostic tool for AMI，while mesenteric angiography remains the gold standard for the diagnosis of AMI. It can show the morphology of vascular lesions, and endovascular treatment can also be carried out simultaneously. Being familiar with the common causes of AMI, finding valuable clues from untypical clinical manifestations, including AMI in the list of suspected and differential diagnosis, and promptly arranging quick and efficient imaging test, one can minimize the time of diagnosing AMI so as to save valuable treatment time for salvaging the ischemic bowel.
出处
《中国实用外科杂志》
CSCD
北大核心
2013年第12期995-997,共3页
Chinese Journal of Practical Surgery
