Kuwabara Y, Kataoka M, Sakakibara K, Furuta Y, Niwa T, Sumita N, Masaoka A
Second Department of Surgery, Nagoya City University Medical School, Japan.
Nihon Geka Gakkai Zasshi. 1991 Jan;92(1):24-30.
This study was undertaken for the purpose of making early diagnosis of acute superior mesenteric artery occlusion (SMAO). (Clinical Study) This study included 16 patients with SMAO. The early diagnoses by clinical, laboratory, echographic and radiologic findings which were commonly obtained in the cases of abdominal emergency, were difficult. Angiography was useful method for its diagnosis. But in its early stage, we could hardly determine which patient was subject to angiography, therefore non-invasive and simple screening modelity is needed for its early diagnosis. (Experimental Study) Portal blood flow (PVF) is considered to decrease when superior mesenteric artery (SMA) is occluded, because SMA is a main feeder of portal vein. If SMAO has specific portal hemodynamics, its early diagnosis will be possible by non-invasive PVF measurement using an ultrasonic duplex system (PD). We investigated the portal hemodynamic changes in experimental SMAO, peritonitis and ileus using 24 mongrel dogs. Our results showed that PVF to cardiac output ratios (PCR) of SMAO models were under 10% and in contrast, those of others were over 10%. So SMAO models were distinguishable from others. These suggested that PCR measured by PD and echocardiography was an useful indicator of early diagnosis of SMAO.
本研究旨在对急性肠系膜上动脉闭塞（SMAO）进行早期诊断。（临床研究）本研究纳入了16例SMAO患者。通过腹部急症病例中常见的临床、实验室、超声和放射学检查结果进行早期诊断存在困难。血管造影是其诊断的有效方法。但在早期阶段，很难确定哪些患者需要进行血管造影，因此早期诊断需要无创且简单的筛查方法。（实验研究）当肠系膜上动脉（SMA）闭塞时，门静脉血流（PVF）会降低，因为SMA是门静脉的主要供血血管。如果SMAO具有特定的门静脉血流动力学特征，那么通过使用超声双功系统（PD）进行无创PVF测量就有可能实现其早期诊断。我们使用24只杂种犬研究了实验性SMAO、腹膜炎和肠梗阻时的门静脉血流动力学变化。我们的结果显示，SMAO模型的PVF与心输出量之比（PCR）低于10%，相比之下，其他模型的该比值超过10%。因此，SMAO模型与其他模型可区分开来。这些结果表明，通过PD和超声心动图测量的PCR是SMAO早期诊断的有用指标。
