慢性肠系膜上动脉狭窄(闭塞)14例误诊讨论  

Misdiagnosis Analysis of 14 Patients with Chronic Superior Mesenteric Artery Stenosis or Occlusion

作　　者：宋盛晗[1] 张望德[1] 原标[1] 杨宝钟[1] 李谈[1] 廖传军[1] SONG Sheng-han ZHANG Wang-de YUAN Biao YANG Bao-zhong LI Tan LIAO Chuan-jun(Department of Vascular Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100020, China)

机构地区：[1]首都医科大学附属北京朝阳医院血管外科,北京100020

出　　处：《临床误诊误治》2016年第12期21-23,共3页Clinical Misdiagnosis & Mistherapy

基　　金：中国医药卫生事业发展基金(20101212)

摘　　要：目的 探讨慢性肠系膜上动脉（SMA）狭窄（闭塞）的临床特点,减少误诊误治。方法 对2006年8月—2015年11月我院收治的误诊为其他疾病的SMA狭窄（闭塞）14例的临床资料进行回顾性分析。结果 本组均因不同程度的上腹部不适或疼痛就诊,先后误诊为慢性胆囊炎、上消化道溃疡、恶性肿瘤等,后经腹部血管超声、CT血管造影、磁共振血管造影等确诊为SMA狭窄（闭塞）,行手术或介入治疗,术后予抗血小板聚集后好转出院。随访6~35个月,患者症状及体征均明显缓解,饮食逐渐恢复正常,其中1例在术后32个月死于心肌梗死,生存期间腹痛未复发。结论 临床遇及餐后上腹部不适、体重减轻等症状与体征不符的患者时,要考虑到本病的可能,尽早完善相关检查是避免或减少误诊的关键。Objective To investigate clinical features of chronic superior mesenteric artery （ SMA） stenosis or occlu-sion in order to avoid misdiagnosis and mistreatment. Methods Clinical data of 14 misdiagnosed patients with chronic SMA stenosis or occlusion admitted during August 2006 and November 2015 was retrospectively analyzed. Results All the 14 pa-tients visited doctors for different degrees of upper abdomen discomfort or pain, and were ever misdiagnosed as having chronic cholecystitis, upper gastrointestinal ulcer and malignant tumors. SMA stenosis or occlusion was confirmed by abdominal vascu-lar ultrasonography, CT angiography and magnetic resonance angiography （MRA）. Interventional or operative therapy and postoperative anti-platelet aggregation treatments were given for all the patients, and the patients were discharged after condi-tions had improved. During 6-35 months of follow-up, all the patients had significant relief of symptoms and signs, and diet gradually returned to normal, But 1 patient died of myocardial infarction 32 months after operation, and the patient had no ab-dominal pain during his survival period. Conclusion Patients with postprandial upper abdomen discomfort and loss of weight, which are inconsistent with signs of abdominal symptoms, the SMA stenosis or occlusion should be taken into account. Related examinations should be performed as quickly as possible in order to avoid or decrease misdiagnosis.

关 键 词：肠系膜血管闭塞 肠系膜动脉 误诊 胆囊炎 消化性溃疡 慢性胃炎 

分 类 号：R572.3[医药卫生—消化系统]