Kolkman Jeroen-J, Bargeman Marloes, Huisman Ad-B, Geelkerken Robert-H
Department of Gastroenterology, Medisch Spectrum Twente, 7500 KA Enschede, The Netherlands.
World J Gastroenterol. 2008 Dec 28;14(48):7309-20. doi: 10.3748/wjg.14.7309.
Splanchnic or gastrointestinal ischemia is rare and randomized studies are absent. This review focuses on new developments in clinical presentation, diagnostic approaches, and treatments. Splanchnic ischemia can be caused by occlusions of arteries or veins and by physiological vasoconstriction during low-flow states. The prevalence of significant splanchnic arterial stenoses is high, but it remains mostly asymptomatic due to abundant collateral circulation. This is known as chronic splanchnic disease (CSD). Chronic splanchnic syndrome (CSS) occurs when ischemic symptoms develop. Ischemic symptoms are characterized by postprandial pain, fear of eating and weight loss. CSS is diagnosed by a test for actual ischemia. Recently, gastro-intestinal tonometry has been validated as a diagnostic test to detect splanchnic ischemia and to guide treatment. In single-vessel CSD, the complication rate is very low, but some patients have ischemic complaints, and can be treated successfully. In multi-vessel stenoses, the complication rate is considerable, while most have CSS and treatment should be strongly considered. CT and MR-based angiographic reconstruction techniques have emerged as alternatives for digital subtraction angiography for imaging of splanchnic vessels. Duplex ultrasound is still the first choice for screening purposes. The strengths and weaknesses of each modality will be discussed. CSS may be treated by minimally invasive endoscopic treatment of the celiac axis compression syndrome, endovascular antegrade stenting, or laparotomy-assisted retrograde endovascular recanalization and stenting. The treatment plan is highly individualized and is mainly based on precise vessel anatomy, body weight, co-morbidity and severity of ischemia.
内脏或胃肠道缺血较为罕见，且缺乏随机研究。本综述聚焦于临床表现、诊断方法及治疗方面的新进展。内脏缺血可由动脉或静脉阻塞以及低流量状态下的生理性血管收缩引起。严重内脏动脉狭窄的患病率较高，但由于丰富的侧支循环，多数情况下仍无症状，这被称为慢性内脏疾病（CSD）。当出现缺血症状时，即发生慢性内脏综合征（CSS）。缺血症状的特征为餐后疼痛、畏食及体重减轻。CSS通过实际缺血检测来诊断。近来，胃肠张力测定已被确认为一种检测内脏缺血及指导治疗的诊断方法。在单支血管CSD中，并发症发生率很低，但部分患者有缺血相关主诉，且可成功治疗。在多支血管狭窄中，并发症发生率较高，多数患者患有CSS，应强烈考虑进行治疗。基于CT和MR的血管造影重建技术已成为用于内脏血管成像的数字减影血管造影的替代方法。双功超声仍是筛查的首选方法。将讨论每种方式的优缺点。CSS可通过对腹腔干压迫综合征进行微创内镜治疗、血管腔内顺行支架置入术或剖腹术辅助的逆行血管腔内再通及支架置入术来治疗。治疗方案高度个体化，主要基于精确的血管解剖结构、体重、合并症及缺血严重程度。
