Department of Radiology, Addenbrooke’s Hospital, Cambridge, UK.
Postgrad Med J. 2013 Mar;89(1049):165-72. doi: 10.1136/postgradmedj-2012-131028. Epub 2012 Dec 14.
Clinicians working in any acute medical/surgical unit need an understanding of mesenteric ischaemia. Acute mesenteric ischaemia is a life-threatening vascular emergency associated with high morbidity and mortality. However, prompt diagnosis with the use of contrast-enhanced CT, more specifically CT angiography, has replaced catheter angiography as the new standard and is readily available in many emergency departments. Similarly, new hybrid open surgery endovascular treatment can minimise the surgical insult to these often critically ill elderly patients. Together, these changes can change the previously grim prognosis associated with this condition. By contrast, chronic mesenteric ischaemia (CMI) is an insidious disease and often a diagnosis of exclusion. However, it can cause a significant reduction in a patient's quality of life, due to 'mesenteric angina' and food avoidance, yet can potentially be treated simply and effectively. Recognition of the typical clinical history and imaging findings is key to making the diagnosis in a timely fashion. Radiology plays a significant role in the diagnosis and increasingly in the treatment of mesenteric ischaemia. Other clinicians should have a basic understanding of what radiology can and cannot offer. The advantages and limitations of commonly used imaging modalities-plain films, CT, MRI and ultrasound, are examined. The significance of findings, such as pneumatosis coli and portal gas are explained. Finally, the different endovascular management of both acute and CMI is discussed, which have emerged as minimally invasive options to complement open revascularisation surgery.
临床医生在任何急性内科/外科病房工作都需要了解肠系膜缺血。急性肠系膜缺血是一种危及生命的血管急症，与高发病率和死亡率相关。然而，使用对比增强 CT（更具体地说是 CT 血管造影）进行及时诊断已取代了导管血管造影术，成为新的标准，并且在许多急诊部门都可获得。同样，新型杂交开放手术血管内治疗可以最大限度地减少对这些经常处于危急状态的老年患者的手术创伤。这些变化共同改变了与这种情况相关的先前严峻预后。相比之下，慢性肠系膜缺血（CMI）是一种隐匿性疾病，通常是排除性诊断。然而，由于“肠系膜心绞痛”和避免进食，它会导致患者生活质量显著下降，但可以通过简单有效的治疗来解决。及时识别典型的临床病史和影像学发现是做出诊断的关键。放射学在肠系膜缺血的诊断中起着重要作用，而且在治疗中越来越重要。其他临床医生应该对放射学可以提供什么和不能提供什么有基本的了解。本文探讨了常用成像方式（平片、CT、MRI 和超声）的优缺点和局限性，解释了结肠积气和门脉积气等发现的意义。最后，讨论了急性和 CMI 的不同血管内治疗方法，这些方法作为补充开放再血管化手术的微创选择已经出现。
