急性肠系膜上动脉闭塞的诊断与治疗

目的 探讨急性肠系膜上动脉闭塞的诊断与治疗.方法 对2000-2007年收治的15例急性肠系膜上动脉闭塞患者的临床资料进行回顾性分析.结果 本组15例患者中肠系膜上动脉栓塞11例,肠系膜上动脉血栓形成4例.入院后均行急诊剖腹探查术,其中2例行肠系膜上动脉取栓术,11例行肠系膜上动脉取栓加坏死肠管切除术,2例放弃手术.术后均行肝素等抗凝治疗.4例死亡,总病死率为27%.结论 对于有器质性心脏病的患者,如突然出现腹部疼痛,应警惕肠系膜上动脉闭塞的可能.早期诊断、早期行肠系膜上动脉取栓术是提高治愈率的关键.

Diagnosis and treatment of acute superior mesenteric artery occlusion

Objective To discuss the manifestations, diagnosis and management of acute superior mesenteric artery occlusion (ASMAO). Methods The clinical data of 15 cases of ASMAO admitted in our hospital between 2000 and 2007 were analyzed retrospectively. Results The causes of ASMAO were mesenteric artery embolism in 11 patients and mesenteric artery thrombosis in 4 patients. All cases underwent emergency laparotomy, in which 2 cases underwent removal of the embolus, 11 cases were subjected to resection of necrotic bowel after removal of the embolus, and 2 cases gave up definite surgery. Postoperative heparin anticoagutherapy was used in all patients. The overall mortality rate was 27% (4 cases). Conclusions Acute superior mesenterie artery occlusion should be suspected in a patient with sudden abdominal pain, especially in those who have organic cardiac disease. Early diagnosis and prompt embolectomy are the key to save the patients.