ObjectiveTo evaluate the value of spiral CT in diagnosing ischemic bowel changes in systemic lupus erythematosus (SLE) patients presenting with acute abdominal pain. MethodsThe clinical data and spiral CT imaging files of 23 SLE patients presenting with acute abdominal pain were retrospectively reviewed. Sixteen had contrastenhanced spiral CT scanning of the abdomen, the rest had plain CT study. Observation emphasis was placed on the changes of bowel wall (wall thickness, enhancement pattern, lumen size) and mesentery (mesenteric edema, engorgement of mesenteric vessels and their abnormal arrangement pattern). Other abnormal findings (e.g. fluid accumulation, changes of abdominal solid organs, lymphadenopathy) were also observed. ResultsNineteen patients had intestinal wall thickening (19/23, 82.6%), with the “target sign” in 12 patients (12/16, 75.0%); Bowel lumen dilatation was present in 16 patients (16/23, 69.6%). Mesenteric swelling with increased density of adipose tissue was noticed in 21 patients (21/23, 91.3%); 18 patients had engorgement of mesenteric vessels (18/23, 78.3%), with comb like arrangement in 4 patients (4/16, 25.0%). Other abnormal findings included ascites, hydrothorax, hydropericardium, hepatosplenomegaly and so on. ConclusionThe most common CT findings in SLE patients presenting with acute abdominal pain are the signs associated with ischemic bowel disease. Contrastenhanced spiral CT is a preferable imaging method for both the diagnosis and differential diagnosis of ischemic bowel disease associated with SLE.
目的 探讨血管介入治疗在急性动脉缺血性肠病早期阶段的价值及应用方法。方法 笔者所在医院2005年8月至2011年12月期间共收治急性动脉缺血性肠病患者9例，其中2008年以前的6例行传统开腹手术治疗，2008年以后的3例患者，在短期内确诊并及时进行了溶栓或取栓治疗。结果 开腹手术治疗的6例患者中，行单纯肠系膜上动脉取栓1例，单纯坏死肠管切除3例，肠系膜上动脉取栓加坏死肠管切除2例；手术后1周内死亡2例（死于多脏器功能衰竭），半年后因短肠综合征死亡1例。行介入治疗的3例患者中，行经导管溶栓治疗2例，球囊取栓加溶栓治疗1例；术后均恢复良好，顺利出院； 术后分别随访6个月、9个月和2年，其中1例术后9个月因脑梗塞死亡。结论 血管介入治疗在急性动脉缺血性肠病的早期诊治方面具有明显的优势，一旦有可疑患者，应迅速进行影像学和血液学方面的检查以明确诊断，非创伤性血管成像技术（CTA）和血管造影（DSA）被认为是最有价值的诊断方法。明确诊断后，专业的血管外科医师的早期干预可以明显改善患者的预后。