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.     

急性肠系膜上动脉栓塞的诊断与治疗

目的: 探讨急性肠系膜上动脉栓塞的诊断与治疗。方法:对近10年收治的急性肠系膜上动脉栓塞患者22例临床资料进行回顾分析。结果:术前确诊率为77.3%，2例非手术治疗者均死亡（病死率100.0%）。20例经手术治疗，其中5例行单纯坏死肠管切除，端端吻合术，3例死亡（病死率60.0%）；15例行肠系膜上动脉取栓加坏死肠管切除，5例死亡（病死率33.3%）。总病死率为45.5%。结论:对于有器质性心脏病的患者，突然出现腹部疼痛，应警惕肠系膜上动脉栓塞的可能。CTA是诊断急性肠系膜上动脉栓塞的有效手段。早诊断、早期行肠系膜上动脉取栓术是提高治愈率的关键。     

急性肠系膜上动脉栓塞21例临床诊疗

探讨急性肠系膜上动脉栓塞的临床诊疗方法。回顾性分析2006年5月—2016年5月收治急性肠系膜上动脉栓塞患者21例。非手术治疗1例,行血管造影尿激酶灌注治疗;肠系膜上动脉切开取栓3例;开腹手术切除坏死肠管15例,从入院到开腹手术时间为(2～42)h,平均(16.2±11.6)h,其中小肠部分切除吻合12例,回肠加右半结肠切除2例,行小肠切除造瘘术1例;2例患者术中告知患者家属后放弃进一步手术治疗。5例手术患者术后并发脓毒血症死亡;2例放弃进一步手术治疗者死亡;切口感染3例,肺部感染2例。即时准确的诊断与治疗是治愈此类疾病的有效方法。     

Fogarty导管取栓介入治疗急性肠系膜上动脉栓塞

目的 探讨Fogarty导管取栓在急性肠系膜上动脉栓塞治疗中的价值。方法 回顾性分析2018年4月至2021年10月我院收治的12例肠系膜上动脉栓塞患者的临床资料。其中,8例采用Fogarty导管取栓,4例辅以球囊扩张成形术及导管接触性溶栓术。Fogarty导管取栓患者栓子均脱落至下肢动脉,再行股动脉切开取栓术。结果 肠系膜上动脉完全开通9例,部分开通3例,无中转开放手术病例。术后随访3～12个月,平均(6.35±3.22)个月。复查CTA示SMA主干及分支动脉显影良好,无明显狭窄及再栓塞。2例患者有轻微消化道症状。结论 Fogarty导管介入取栓必要时联合球囊扩张成形术及导管接触性溶栓术治疗急性肠系膜上动脉栓塞,创伤小、恢复快,临床疗效满意,值得推广。     

急性肠系膜上动脉栓塞的诊断与治疗(附15例报告)

目的探讨急性肠系膜上动脉栓塞(SMAE)的临床特点及诊疗策略。方法回顾性收集并分析15例急性SMAE患者的临床资料,其中男12例,女3例;年龄44~77岁,平均(62.5±11.3)岁,从症状发作至入院的间隔时间为3小时至5天。结果 9例患者术前得到确诊。7例初始接受介入溶栓治疗的患者中有2例中转接受部分肠管切除手术。8例患者立即接受开腹手术,其中2例为单纯剖腹探查,2例为肠系膜动脉取栓术,1例为部分肠管切除术,其余3例同时接受肠系膜动脉取栓和部分肠管切除术。8例患者死亡,死亡率为53.3%。结论临床医生应提高对急性SMAE的认识,早期诊断疾病并及时进行介入溶栓或手术治疗,提高患者的生存率。     

急性肠系膜上动脉栓塞的手术探讨

目的总结手术治疗急性肠系膜上动脉栓塞的临床体会,探讨常见并发血管病变的处理方法。方法1990年1月～2005年12月年收治32例急性肠系膜上动脉栓塞患者,均在全身麻醉下行肠系膜动脉切开取栓,同时处理合并的内脏血管病变。结果30例获得临床治愈,2例分别死于呼吸衰竭和心力衰竭。术后1年复查无栓塞及局部狭窄,CTA示肠系膜上动脉通畅,侧枝循环正常。30例术后随访2～15年,23例无局部狭窄或复发,7例死于心肌梗塞或脑出血。结论早期诊断、早期切开取栓同时处理伴发疾病,可显著提高急性肠系膜上动脉栓塞的临床治愈率。     

外科治疗急性动脉栓塞与急性动脉血栓形成疗效分析

目的比较外科治疗急性动脉栓塞与急性动脉血栓形成的疗效。方法回顾性分析58例急性动脉栓塞或急性动脉血栓形成导致的急性下肢缺血病例,所有病例均采用外科手术治疗,其中31例急性动脉栓塞(A组)和9例急性动脉血栓形成(B1组)采用单纯股动脉切开Fogarty导管取栓术,18例急性动脉血栓形成(B2组)采用股动脉切开内膜剥脱+Fogarty导管取栓术。术后随访1 a,比较各组治疗效果和截肢率。结果动脉栓塞组术后治疗成功率及好转率高于动脉血栓形成组(P<0.05),截肢率低于动脉血栓形成组(P<0.05);动脉血栓形成A组术后治疗成功率及好转率低于动脉血栓形成B组(P<0.05),截肢率差异无统计学意义(P>0.05)。结论股动脉切开Fogarty导管取栓术治疗急性动脉栓塞疗效较急性动脉血栓形成理想;内膜剥脱+Fogarty导管取栓术治疗下肢动脉血栓形成疗效优于单纯Fogarty导管取栓术,截肢率无明显差别。     

急性肠系膜上动脉栓塞的外科治疗

目的:探讨急性肠系膜上动脉栓塞的诊断方法和治疗原则。方法:13例病人中10例病程在12h内,采用Fogaty导管取栓并配合药物抗凝、溶栓治疗。3例病程在24h以上,术中发现肠管坏死,行肠管切除术。结果:3例肠坏死者术后5d、7d、9d因原发疾病严重并多器官功能衰竭而死亡,10例治愈。1~5年随访,3例死于心脏病,7例均未再发生肠系膜栓塞。治愈率53.8%,死亡率46.2%。结论:痉挛性腹痛、器质性心脏病、胃肠道排空异常是本病早期诊断的主要临床特点,早期诊断和及时手术取栓是治疗的有效手段。     

急性肠系膜上动脉栓塞的介入治疗

目的　评价经皮肠系膜上动脉吸栓治疗急性肠系膜上动脉栓塞的疗效。　方法　 7例急性肠系膜上动脉栓塞的患者 (心房纤颤 4例 ;左房粘液瘤 2例 ;慢性缺血性肠病 1例 ) ,行经皮动脉长鞘 (Optimed公司 )吸栓术。　结果　 7例均成功取出栓子 ,动脉开通。 5例痊愈 ;1例行开腹探查 ;1例 2 4小时后死亡。　结论　经皮长鞘吸栓术对于治疗急性肠系膜上动脉栓塞 ,是一种简便有效的方法     

切开取栓及肠管外置治疗肠系膜上动脉栓塞六例

肠系膜上动脉栓塞(SMAE)起病之初难以诊断,预后差。现将我们对6例SAME患者采取切开取栓及肠管外置后收到满意疗效的体会报告如下。临床资料6例患者中男5例、女1例,年龄48～81岁。6例患者均表现为全腹剧痛及恶心、呕吐,2例出现血便,全组查体均有房颤,4例有腹肌紧张、压痛、反跳痛。全组发病至手术为8h～5d。多普勒检查6例,2例发现肠系膜上动脉(SMA)栓子。螺旋CT检查6例均示SMAE。数字减影血管造影术(DSA)检查1例示主干栓塞。术中行SMA根部切开,Fogarty导管SMA近端取栓,向SMA远端注入尿激酶,切除坏死小肠。观察肠管颜色红润,边缘…     

Embolization of the mesenteric arteries: Surgical treatment in twenty-three consecutive cases

Twenty-three patients with acute embolization of the superior mesenteric acrtery are presented. Twenty-one of them presented with sudden abdominal pain but no other remarkable physical findings. One had diffuse abdominal pain while one did not have any abdominal pain. Twenty-two, patients underwent direct surgical revascularization and one patient, refused operation. The total mortality in this series was 27%. Eighteen patients underwent revascularization without resection and 15 of them (83%) survived. Early diagnosis is the key to improved results in acute mesenteric ischemia. It relies on the aggressive utilization of arteriography to identily patients with superior mesenteric artery embolization before intestinal infarction takes place.     

Revascularization in treatment of mesenteric infarction.

This study compares results of primary revascularization with primary intestinal resection in treatment of acute mesenteric artery occlusion in 48 surgical patients. All cases were verified by surgical exploration, angiography or autopsy. Fifteen occlusions were caused by mesenteric thrombosis and 33 by superior mesenteric artery embolization. Primary revascularization was done in 6 of 15 patients with arteriosclerotic mesenteric thrombosis. Total bowel salvage was achieved in 4 patients but no patient with mesenteric thrombosis treated by any method survived long term. Primary embolectomy was done in 11 patients with superior mesenteric artery embolization. Ttoal bowel salvage was achieved in 8 patients. Three of 11 patients died. Primary exploration and/or resection was done in 11 patients; 9 died. All 11 umoperated patients died. A continuation of attempts at mesenteric revascularization is advocated.     

Contemporary management of acute mesenteric ischemia: Factors associated with survival

PURPOSE: Acute mesenteric ischemia (AMI) is a morbid condition with a difficult diagnosis and a high rate of complications, which is associated with a high mortality rate. For the evaluation of the results of current management and the examination of factors associated with survival, we reviewed our experience. METHODS: The clinical data of all the patients who underwent operation for AMI between January 1, 1990, and December 31, 1999, were retrospectively reviewed, clinical outcome was recorded, and factors associated with survival rate were analyzed. RESULTS: Fifty-eight patients (22 men and 36 women; mean age, 67 years; age range, 35 to 96 years) underwent study. The cause of AMI was embolism in 16 patients (28%), thrombosis in 37 patients (64%), and nonocclusive mesenteric ischemia (NMI) in five patients (8.6%). Abdominal pain was the most frequent presenting symptom (95%). Twenty-five patients (43%) had previous symptoms of chronic mesenteric ischemia. All the patients underwent abdominal exploration, preceded with arteriography in 47 (81%) and with endovascular treatment in eight. Open mesenteric revascularization was performed in 43 patients (bypass grafting, n = 22; thromboembolectomy, n = 19; patch angioplasty, n = 11; endarterectomy, n = 5; reimplantation, n = 2). Thirty-one patients (53%) needed bowel resection at the first operation. Twenty-three patients underwent second-look procedures, 11 patients underwent bowel resections (repeat resection, n = 9), and three patients underwent exploration only. The 30-day mortality rate was 32%. The rate was 31% in patients with embolism, 32% in patients with thrombosis, and 80% in patients with NMI. Multiorgan failure (n = 18 patients) was the most frequent cause of death. The cumulative survival rates at 90 days, at 1 year, and at 3 years were 59%, 43%, and 32%, respectively, which was lower than the rate of a Midwestern white control population (P <.001). Six of the 16 late deaths (38%) occurred because of complications of mesenteric ischemia. Age less than 60 years (P <.003) and bowel resection (P =.03) were associated with improved survival rates. CONCLUSION: The contemporary management of AMI with revascularization with open surgical techniques, resection of nonviable bowel, and liberal use of second-look procedures results in the early survival of two thirds of the patients with embolism and thrombosis. Older patients, those who did not undergo bowel resection, and those with NMI have the highest mortality rates. The long-term survival rate remains dismal. Timely revascularization in patients who are symptomatic with chronic mesenteric ischemia should be considered to decrease the high mortality rate of AMI.     

Mesenteric vascular problems. A 26-year experience.

Mesenteric vascular problems are infrequent, but may be catastrophic. During a 26-year period, 55 private patients were treated for the following disorders: (1) 12 patients with visceral artery aneurysms, (2) 8 with celiac compression syndrome, (3) 13 with chronic mesenteric ischemia, (4) 12 with acute mesenteric ischemia, and (5) 10 with mesenteric ischemia associated with aortic reconstructions. Splenic artery aneurysms were managed by excision and splenectomy, while celiac and hepatic had excision with graft replacement. Patients with celiac compression syndrome underwent lysis of the celiac artery. Two patients had compression of both celiac and superior mesenteric artery (SMA). One patient required vascular reconstruction of both arteries for residual stenoses. Patients having chronic mesenteric ischemia were treated with bypass grafts, with one death (7.7% mortality) and good long-term results. Those with acute mesenteric ischemia were treated by SMA embolectomy, bowel resection, or both, with a mortality of 67%. When associated with aortic reconstructions, mesenteric ischemia carried a mortality of 100% if bowel infarction occurred after operation, but when prophylactic mesenteric revascularization was performed at the time of aortic surgery, prognosis was greatly improved, with only one death among six patients. An aggressive approach including prompt arteriography with early diagnosis and surgical therapy is advocated for these catastrophic acute mesenteric problems.     

Acute mesenterial infarcts--results of surgical therapy

Forty-five patients with mesenteric infarction documented by laparotomy or autopsy were reviewed. 35% of the patients had superior mesenteric artery occlusion by embolus, 27% by thrombosis, 11% had venous thrombosis, 9% nonocclusive mesenteric ischemia, and 18% were unclear. The mortality rate was 60% within half a year postoperatively. 22% had inoperable lesions, 46% underwent bowel resection, and 32% were managed by revascularization. In the group treated by bowel resection (n = 21) 30% died, in the group treated by revascularization 80% of the patients died.     

Nonocclusive mesenteric ischemia after off-pump coronary artery bypass surgery: a word of caution

We present a series of five cases of off-pump coronary artery bypass surgery complicated with fatal nonocclusive mesenteric ischemia. We review a total of 489 patients aged 65 and older (mean age 74.9 +/- 3.2 years) who underwent off-pump coronary artery bypass surgery. The diagnosis of nonocclusive mesenteric ischemia was confirmed by computed tomography-angiography and/or selective angiography of the superior mesenteric artery, or intraoperatively. Three patients underwent laparotomy with bowel resection. In two cases, resection of bowel was not feasible. Of the possible predisposing factors, we found that four of the patients (two preoperative and two perioperative) had received epinephrine and two had an intra-aortic balloon counter pulsation due to acute myocardial infarction and cardiogenic shock. All patients were over 65 years of age, and all had acute anterior wall myocardial infarction and hemodynamic instability or post-myocardial infarction unstable angina. Nonocclusive mesenteric ischemia is a difficult clinical entity to recognize, has no clear-cut effective management, has a poor prognosis as a result of low cardiac output, and can be aggravated by off-pump coronary artery bypass grafting.     

外科治疗肠系膜上动脉栓塞的临床分析

目的: 探讨急性肠系膜上动脉栓塞早期诊断及取栓的临床疗效。方法:回顾性分析1999－2005年，21例肠系膜上动脉栓塞的临床资料。根据患者从发病到手术间隔的时间长短分为2组：Ι组为发病后6h内进行手术治疗者，9例;Ⅱ组为发病6h后进行手术治疗者，12例。所有取栓患者术中在动脉内灌注尿激酶，术后应用肝素抗凝。结果:取栓和局部应用尿激酶后，观察30min，发现12例小肠血运恢复正常，其中Ι组9例全部恢复，Ⅱ组有3例恢复。Ι组无行肠切除者;Ⅱ组中有9例（75.0%）进行了肠切除，4例为局部切除，5例为长段肠管切除。Ι组病死率为0，Ⅱ组为41.6%。结论:早期诊断及及时治疗有助于减少肠坏死及降低病死率。     

急性肠系膜上动脉栓塞的诊断与治疗(附12例报告)

目的　探讨急性肠系膜上动脉栓塞的诊断与治疗。方法　对 1995～ 2 0 0 2年收治的急性肠系膜上动脉栓塞患者 12例的临床资料进行回顾分析。结果　 12例全部经手术治疗 ,3例行肠系膜上动脉取栓加坏死肠管切除、端端吻合术 ,9例行单纯坏死肠管切除、端端吻合术。 7例痊愈 ,5例死亡 ,死亡率 4 2 %。结论　增强对本病的认识 ,及时诊断 ,早期手术是提高治愈率的关键。