急性肠系膜血管供血不全的早期诊断和治疗

急性肠系膜血管供血不全在临床急腹症中虽不常见，一旦发生即呈凶险重症。临床常因认识不足而延误诊断和治疗，是近年文献报告死亡高居高不下的主要原因。作者对我院１９６０年至１９９４年急性肠系膜血管供血不全２３例的临床资料进行了分析．指出有外周动脉栓塞史和发生动脉栓塞同时伴有剧烈腹痛和早期出现呕吐伴啡样物和或便血症状，以及腹疼对镇痛剂无效者，应视为肠系膜上动脉供血不足的早期症兆。对早期诊断和治疗进行了综合性讨论。并主张应积极开展肠系膜上动脉切开取栓术。     

急性肠系膜血管供血不全的诊断和治疗

目的：探讨急性肠系膜血管供血不全的诊断和治疗方法。方法：回顾性分析30例急性肠系膜血管供血不全的临床资料。26例(86．7％)年龄大于60岁；17例(56．7％)合并有心血管疾病及其它疾病。27例行急诊手术治疗，其中23例行小肠部分切除吻合术，2例行肠系膜上动脉取栓术，2例因肠系膜上动脉广泛梗塞、小肠广泛坏死未作处理。结果：25例(83．3％)发生绞窄性肠梗阻。3例因病情危重，未经手术即死于感染性休克和心肺功能衰竭。余27例均经手术治疗，治愈14例(46．7％)，死亡13例，总病死率53．3％。结论：充分认识该病，选用恰当的检查技术早期诊断，及时手术，是提高急性肠系膜血管供血不全治疗效果的关键。     

急性肠系膜血管供血不全的早期诊断和治疗

急性肠系膜血管供血不全在临床急腹症中虽不常见，一旦发生即呈凶重症。临床常因认识不足而延误诊断和治疗，是近年文献报告死亡高居高不下的主要原因。对早期诊断和治疗进行综合性讨论，并主张应积极开展系膜上动脉切开取栓术。     

有关腹部血管病外科的急症处理

由腹部血管病引起的急腹症虽不常见,但一旦发生常为凶险重症。经常意识到此类重症的存在是及早作出诊断和挽救患者生命的前提。以下疾病属此范畴:急性肠系膜血管供血不全、腹主动脉瘤破坏、夹层动脉瘤形成,急性腹主动脉阻塞、腹腔轴压迫综合症(Celiac Axis Compressive Syndrome)和腹部大     

急性肠系膜血管缺血的外科治疗体会

急性肠系膜缺血性疾病是一种发病率低且病死率高的缺血性肠疾病,主要病因为急性肠系膜动脉栓塞、血栓形成,肠系膜血管受压或痉挛和肠系膜静脉血栓形成等.上海复旦大学附属中山医院血管外科自2003年至2007年共收治急性肠系膜缺血患者19例,其中10例行早期血供重建,现报告如下.     

急性肠系膜动脉栓塞误诊2例报告

血运性肠梗阻是肠系膜血管阻塞或血流不足引起肠壁血供障碍的一种急腹症，急性肠系膜动脉栓塞可在短时间内导致小肠及部分结肠广泛坏死，病情凶险预后极为恶劣，术前诊断困难、死亡率高；早期诊断、及时处理是提高此病生存率的关键，本院曾收治2例，现将诊治教训报告如下。     

超声检查在肠系膜上动脉栓塞性疾病诊断中的应用价值

肠系膜上动脉栓塞性疾病包括肠系膜上动脉栓塞（occlusion of superior mesenteric artery）和肠系膜上动脉血栓形成（SMA thrombosis formation），其发生率在肠系膜血管性病变中占1／3以上，占所有外科急腹症住院病人的0．9％，亦属血运性肠梗阻范畴。根据栓塞部位、大小或血栓蔓延及侧支循环情况，将会发生不同程度的肠坏死或缺血性肠病（ischemic bowel disease）。系由肠系膜血管阻塞或狭窄引起的血流灌注及供血不全，被供血区域肠襻出现缺血、肠壁营养障碍和进而发生肠梗死所最终导致的结果。     

急性肠系膜血管阻塞性疾病16例诊疗体会

目的:探讨急性肠系膜血管阻塞性疾病的诊断和治疗方法.方法:对我院自2000年1月至2008年12月收治的16例急性肠系膜血管阻塞性疾病的临床资料进行回顾性分析.结果:16例患者中有9例为急性肠系膜静脉血栓形成,7例为急性肠系膜动脉闭塞性疾患,其中1例同时存在肠系膜静脉以及动脉的闭塞.腹部X线以及B超检查对于该病诊断敏感性较低,而增强CT扫描则有较高敏感性.手术治疗13例,围手术期死亡3例,3例急性肠系膜静脉血栓形成患者保守治疗成功.结论:增强CT检查对于急性肠系膜血管阻塞性疾病有较高的诊断价值.早期诊断、积极的抗凝治疗、适时的手术干预是提高治疗效果的关键.     

急性肠系膜血管缺血性疾病的早期诊断和治疗（附14例报告）

目的 探讨急性肠系膜缺血性疾病的早期诊断和治疗方法。方法 分析1987年1月－2001年12月急性肠系膜缺血性疾病14例临床资料。结果 急性肠系膜上动脉栓塞6例，急性肠系膜上动脉血栓形成3例，急性肠系膜上静脉血栓形成4例，非血管阻塞性急性肠缺血1例，均经病理证实。10例有与腹部体征不相符的剧烈腹痛，6例存在慢性肠缺血表现。选择性肠系膜动脉造影确诊1例，CT确诊2例，11例为术中发现。14例均行手术治疗，术后均行溶栓，抗凝治疗，9例治愈，5例死亡。结论 （1）器质性心脏病，动脉硬化，血栓等病史伴与腹部不相符的剧烈腹痛是急性肠系膜缺血性疾病的重要临床特征；（2）选择性动脉造影和CT是最有价值的诊断方法；（3）血管的再管化，必要的肠切除和术前，后抗凝及溶栓是提高疗效的重要保证；（4）出现慢性肠缺血再表现时，预防性抗凝可能是降低死亡率的有效方法。     

急性肠系膜上动脉栓塞的诊治

肠系膜上动脉栓塞（superior mesenteric artery embolism，SMAE）是指栓子进入肠系膜上动脉，发生急性完全性血管闭塞。SMAE可使肠系膜上动脉血供突然减少或消失，导致肠壁肌肉功能障碍，肠急性缺血、坏死；是小肠血运障碍性肠梗阻中最常见的一种，约占急性肠系膜血管缺血性疾病的50％ 。临床上SMAE是一种少见的疾病，年发病率约为8．6／10万 ，但其一旦发生，病情极其凶险，病死率极高，达70％～100％ 。过去由于诊疗技术的落后，往往延误诊断。近年来，诊疗技术的进步，该病的术前确诊率有了很大提高。但该病的发生率有升高趋势 ，因此对本病应高度重视。     

急性肠系膜血管缺血性疾病误诊分析

目的探讨急性肠系膜血管缺血性疾病的误诊原因、诊断和治疗.方法回顾性分析1965～1999年急性肠系膜血管缺血性疾病20例临床资料.结果20例均经病理证实.初诊时多因表现为急腹症、症状与体症不符和缺乏特异性检查而误诊.19例行手术治疗,其中11例治愈,8例死亡;另1例因误诊时间过长,未能及时手术,终导致死亡.结论该病少见,症状和体征无特异性,易造成误诊.选择性动脉造影和D-二聚体检测是较敏感的检查,对诊断有积极作用.早期适当范围切除坏死肠段和术后抗凝治疗是防止复发、降低病死率的重要措施.     

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??Diagnosis and treatment of acute mesenteric arterial ischemia: A report of 28 cases WU Zhang-min??TANG Xiao-bin,KOU Lei, et al. Department of Vascular Surgery??Beijing Anzhen Hospital??Capital Medical College??Beijing 100029??China
Corresponding author??CHEN Zhong, E-mail??chenzhong8658@vip.sina.com
Abstract Objective To conclude the diagnosis and treatment experience for acute mesenteric arterial ischemia disease. Methods The clinical data of 28 patients suffered from acute mesenteric ischemia admitted from 2004 to 2013 in Department of Vascular Surgery, Beijing Anzhen Hospital of Capital Medical College were analyzed retrospectively. The data include medication and surgery. Results Among the total 28 patients??11 patients underwent thrombolectomy by Fogarty catheter including 6 patients underwent bowel resection??and the other 17 patients received conservative medication therapy. Two patients??7.1%??died. Conclusion It is urgent to diagnose and treat the acute superior mesenteric ischemic diseases. The medication and surgery are important methods to save patients’ live.     

Radiology in intestinal ischemia. Plain film, contrast, and other imaging studies.

Because plain films are usually normal or nonspecific in both colonic and acute mesenteric ischemia, they are not diagnostically helpful. The barium enema is the most useful radiographic examination in the diagnosis of colonic ischemia, and a double-contrast study will show abnormalities in almost all cases. Findings specific for colonic ischemia characteristically change with time. Thumbprinting is the most diagnostic finding; it is seen early in the course of the disease and usually resolves or is replaced within 1 or 2 weeks by an acute ulcerating colitis pattern. The latter may heal over months or go on to stricture formation or a persistent colitis. Nonspecific abnormalities can also be identified on CT and ultrasound, but the incidence of the findings with colonic ischemia is not known. Plain film findings occur late in the course of acute mesenteric ischemia and thus cannot be relied on for the diagnosis, although they may be useful in excluding other conditions. When acute mesenteric ischemia is suspected, angiography should be performed, but CT, ultrasound, and, perhaps, MR imaging may contribute to the diagnosis.     

急性肠系膜缺血性疾病的诊断与治疗

目的总结急性肠系膜缺血性疾病的早期诊治经验。方法回顾性分析1988—2005年间诊治的35例急性肠系膜缺血性疾病病人的临床资料。发生在肠系膜动脉30例，肠系膜静脉5例。主要临床表现为急性腹痛（94％）；51％的病人有血清酶谱异常。结果全部病例均通过手术得以证实。4例行肠系膜上动脉置管溶栓，15例行Fogarty导管取栓术，16例行肠管切除。总病死率为23％，肠管坏死病例病死率为50％，多例病人术后出现再灌注损伤。结论动态观察血清酶谱变化有助于该类疾病的早期诊断，对术后再灌注损伤要高度重视。     

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??Interventional therapy for acute mesenteric arterial ischemia LIU Bing??WANG Hai-jun. Department of Vascular Surgery??the First Affiliated Hospital of Harbin Medical University??Harbin 150001??China
Corresponding author??WANG Hai-jun??E-mail??13836162963@163.com
Abstract Acute superior mesenteric artery ischemia is a fatal emergency with multiple etiology??including acute mesenteric arterial embolus and thrombus??nonocclusive mesenteric ischemia and other rare conditions. The progression of the disease will eventually lead to massive intestinal necrosis with high mortality. Early diagnosis and operation can reduce the mortality effectively. The first choice of early treatment for acute superior mesenteric artery ischemia is interventional therapy??meanwhile essential strict indication and operation skill should be known well.     

L’ischémie mésentérique chronique

Chronic mesenteric ischemia concerns patients with obliterant arteriopathy of digestive arteries. Clinical presentation is typical but often unrecognized, so-called mesenteric angor, which is associated with chronic abdominal post prandial pain, alimentary fear, and malnutrition. The evolution of this syndrome is progressive and can lead to fatal acute mesenteric ischemia. Diagnosis of chronic mesenteric ischemia is possible only if two of the three digestive arteries are involved. Because of the lack of digestive abnormalities in the earlier stage of this disease, diagnosis is difficult. The aims of the treatment are to treat symptoms to prevent acute mesenteric ischemia. Two therapeutical options are offered to physicians, surgical or endovascular revascularization.     

Diagnosis and management of acute mesenteric ischemia

The prevalence of significant splanchnic arterial stenoses is increasing, but remains mostly asymptomatic due to abundant collateral circulation. Acute insufficiency of mesenteric arterial blood flow accounts for 60 to 70% of cases of mesenteric ischemia and results mostly from a superior mesenteric embolus. Despite major advances have been achieved in understanding the pathogenic mechanisms of bowel ischemia, its prognosis remains dismal with mortality rates about 60%. The diagnosis of acute mesenteric ischemia depends upon a high clinical suspicion, especially in patients with known risk factors. Rapid diagnosis is essential to prevent intestinal infarction. However, early signs and symptoms of mesenteric ischemia are non specific, and definitive diagnosis often requires radiologic examinations. Early and liberal implementation of angiography has been the major advance over the past 30 years which allowed increasing diagnostic accuracy of acute mesenteric ischemia. CT and MR-based angiographic techniques have emerged as alternatives less invasive and more accurate to analyse splanchnic vessels and evaluate bowel infarction. The goal of treatment of patients with acute mesenteric ischemia is to restore intestinal oxygenation as quickly as possible after initial management that includes rapid hemodynamic monitoring and support. Surgery should not be delayed in patients suspected of having intestinal necrosis.     

Nonocclusive acute mesenteric ischemia

The authors present one case of acute mesenteric ischemia appeared to the patient 70 years old, with HTA and coronary heart disease with heart arrhythmia treated with angiotensin-converting-enzyme inhibitor, anti arrhythmia agents and antithrombin therapy (trombostop). Acute mesenteric ischemia is not an isolated clinical entity, but a complex of diseases, including acute mesenteric arterial embolus and thrombus, mesenteric venous thrombus and nonocclusive mesenteric ischemia. These diseases have common clinical features caused by impaired blood perfusion of the intestine, bacterial translocation and systemic inflammatory response syndrome. Reperfusion injury is another important feature of nonocclusive mesenteric ischemia. We discuss about the nonocclusive mesenteric ischemia is the most lethal form of acute mesenteric ischemia because of the poor understanding of its pathophysiology and its nonspecific symptoms, which often delay its diagnosis. Although acute mesenteric ischemia is still lethal and in-hospital mortality rates have remained high over the last few decades, accumulated knowledge on this condition is expected to improve its prognosis.     

急性肠系膜动脉缺血的介入治疗

急性肠系膜缺血是较为少见的外科急重症,包括肠系膜动脉的栓塞和血栓形成、非阻塞性肠系膜缺血以及其他少见病因。病情发展最终导致大面积肠坏死,病死率极高。早期诊断和及时的手术干预能有效降低病死率。介入治疗是急性肠系膜动脉缺血早期首选治疗手段,需严格掌握适应证和操作技巧。