ISSN 1004-4140
CN 11-3017/P
程晓悦, 贺文. 血管源性急腹症CT诊断及应用[J]. CT理论与应用研究, 2018, 27(5): 643-651. DOI: 10.15953/j.1004-4140.2018.27.05.11
引用本文: 程晓悦, 贺文. 血管源性急腹症CT诊断及应用[J]. CT理论与应用研究, 2018, 27(5): 643-651. DOI: 10.15953/j.1004-4140.2018.27.05.11
CHENG Xiao-yue, HE Wen. CT Diagnosis and Applications of Acute Abdominal Vascular Disease[J]. CT Theory and Applications, 2018, 27(5): 643-651. DOI: 10.15953/j.1004-4140.2018.27.05.11
Citation: CHENG Xiao-yue, HE Wen. CT Diagnosis and Applications of Acute Abdominal Vascular Disease[J]. CT Theory and Applications, 2018, 27(5): 643-651. DOI: 10.15953/j.1004-4140.2018.27.05.11

血管源性急腹症CT诊断及应用

CT Diagnosis and Applications of Acute Abdominal Vascular Disease

  • 摘要: 目的:通过回顾性分析血管源性急腹症患者的增强CT表现、临床特征及超声结果,以总结诊断经验,提高对此类患者的诊断水平。方法:回顾性分析自2012年1月至2017年3月在我院急诊科以腹痛为主诉就诊并行急诊腹部CT检查的患者,选取CT影像表明其为血管源性,且临床确诊为血管源性急腹症的患者共156例,根据不同的血管病变类型及受累的血管不同,分为5大类疾病,并分别统计各类疾病的病例数、典型CT影像表现及超声阳性率。结果:156例患者共分为以下5大类疾病:①动脉夹层及动脉瘤53例,其中动脉夹层17例,包括15例为胸主动脉夹层向下延续,1例单发于腹主动脉下段局限小夹层,1例腹主动脉至右髂总动脉夹层;动脉瘤36例,其中腹主动脉瘤30例、腹主动脉假性动脉瘤3例、1例脾动脉假性动脉瘤、1例腹主动脉瘤支架术后破裂形成血肿、1例单纯右侧髂总动脉瘤。②肠系膜血管疾病30例,其中肠系膜上动脉栓塞12例、肠系膜下动脉栓塞1例、肠系膜静脉栓塞15例(其中5例合并门脉栓塞)、1例肠系膜上动脉夹层、1例肠系膜上动脉壁间血肿。③门脉系统疾病52例,其中门脉高压19例,门脉血栓17例,门脉癌栓9例,门脉海绵样变3例,门脉积气4例。④脾梗死或肾梗死共12例。⑤其他类型血管源性急腹症共9例。结论:增强CT检查在诊断血管源性急腹症比CT平扫、超声检查有更大的优势,不同类型血管源性急腹症有不同的典型CT表现,临床及影像科医生均需要加强对该病的认识和重视程度,总结诊断经验,减少误诊和漏诊,最终提高对此类患者的诊断水平。

     

    Abstract: Objective: To review the CT manifestations, clinical features and ultrasonic results of patients with Acute abdominal vascular disease, and summarize the diagnostic experience to improve the diagnosis. Method: 156 cases with acute abdomen vascular disease of clinical data and imaging data underwent emergency abdominal CT examination in the emergency department of our hospital from January 2012 to March 2017, are analyzed retrospectively. According to the different types of vascular lesions and the different vessels involved, the cases are divided into five major types, and the number of cases, the typical CT image performance and the positive rate of ultrasound are analyzed respectively. Results: The classification as follows:(a) Arterial dissection and aneurysm (53 cases). Among them, there were 17 cases of arterial dissection, including 15 cases of thoracic aortic dissection downward continuation, 1 cases of limited dissection of the inferior segment of abdominal aorta, 1 cases of abdominal aortic dissection extending to the right iliac artery; and 36 cases of aneurysm:including 30 cases of abdominal aortic aneurysm, 3 cases of abdominal aorta pseudoaneurysm, 1 case of splenic artery pseudoaneurysm, 1 case of rupture of abdominal aortic aneurysm after stent implantation and 1 case of right iliac artery aneurysm. (b) Mesenteric vascular diseases (30 cases). Among them, there were 12 cases of superior mesenteric artery embolism, 1 cases of inferior mesenteric artery embolism, 15 cases of mesenteric vein embolism (including 5 cases with portal vein embolism), 1 case of superior mesenteric artery dissection and 1 cases of mesenteric artery intramural hematoma. (c) Portal vein system diseases (52 cases). Among them, there were 19 cases of portal hypertension, 17 cases of portal vein thrombosis, 9 cases of portal vein tumor thrombus, 3 cases of cavernous change of portal vein, and 4 cases of portal venous gas. (d) Spleen infarction or renal infarction (12 cases). e) Other types of acute abdominal vascular disease (9 cases). Conclusion: For acute abdominal vascular disease, enhanced CT has a greater advantage than plain CT and ultrasound. Different types of acute abdominal vascular disease have different typical CT manifestations. Both clinical and imaging doctors need to strengthen the recognition and attention to the disease, summarize the diagnostic experience, reduce misdiagnosis and misdiagnosis, and finally improve the level of diagnosis of this kind of disease.

     

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