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1995～2002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42％。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。     

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.     

急性肠系膜血管闭塞的诊治经验（附16例报告）

目的　探讨急性肠系膜血管闭塞 (AMVO)的早期诊断和治疗。方法　 8例急性肠系膜动脉栓塞 (MAE)确诊 5例 ,误诊 3例。保守治疗 1例 ,介入溶栓 1例 ,肠切除 4例 ,取栓后肠切除 1例 ;另 1例大部小肠严重缺血 ,经二次手术探查 ,避免了肠切除和短肠综合征。 8例急性肠系膜静脉血栓形成 (MVT)确诊 4例 ,疑诊 4例 ;保守治疗 2例 ,肠切除 2例 ,取栓后肠切除 4例。结果　 8例MAE治愈 5例 ,死亡 3例 ;8例MVT全部治愈。结论　对AMVO保持警惕 ,早期确诊是提高疗效的关键。     

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。     

62例急性肠系膜上动脉栓塞的诊断和治疗

目的探讨急性肠系膜上动脉栓塞的临床表现及早期诊断和治疗方法。方法回顾性分析62例急性肠系膜上动脉栓塞患者的临床资料。结果术前确诊22例(35.5%)。62例患者均行肠系膜上动脉切开取栓,58例患者行坏死肠管切除术,其中35例患者行多次肠管切除术。术后16例患者死亡(25.8%)。术后随访3～24个月。结论肠系膜上动脉栓塞误诊率高,病死率高。对心律失常特别是房颤、心脏瓣膜病及既往有急性动脉栓塞病史患者突发剧烈腹痛,应警惕肠系膜上动脉栓塞可能。肠系膜上动脉切开取栓是治疗急性肠系膜上动脉栓塞缩小肠管切除范围有效方法。     

急性肠系膜上动脉栓塞肠坏死不同手术方式的预后分析

目的:总结治疗急性肠系膜上动脉栓塞肠坏死的临床经验,探讨影响其预后的危险因素。方法:回顾性分析2008年1月至2020年12月空军军医大学附属西京医院收治的急性肠系膜上动脉栓塞肠坏死患者的临床资料、手术方式、并发症及术后短期随访结果。结果:46例患者30 d总病死率为19.6%,其中肠切除肠造瘘组30 d病死率为12....     

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。     

急性动脉缺血性肠病的早期诊断及治疗

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。     

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。     

Surgical therapy for acute superior mesenteric artery embolism

BACKGROUND: Acute mesenteric artery embolism has a high rate of morbidity and mortality. Early diagnosis and appropriate treatment are the most important factors associated with morbidity and mortality. METHODS: During the period between 1997 and 2002, 24 patients underwent superior mesenteric artery embolectomy. The patients were divided into three groups according to the onset of symptoms and operation time. Group I (n = 12) patients were operated on in the first 6 hours after onset of symptoms; group II (n = 9) patients were operated on between 6 and 12 hours after onset; and group III (n = 3) patients underwent embolectomy after 12 hours. Low-dose (5 to 10 mg) local tissue-type plasminogen activator (t-PA) administration directly into the superior mesenteric artery was an additional procedure with the embolectomy in all patients. RESULTS: The macroscopic view of the intestine was normal in 15 patients (12 patients in group I and 3 patients in group II) 30 minutes after the administration of local t-PA. Segmental resection was necessary in 4 patients in group II. Extended resection was necessary in 2 patients in group II and 3 patients in group III, and all of the patients died during the early postoperative period. CONCLUSIONS: We suggest that explorative laparotomy should be done in patients with sudden abdominal pain, nausea, vomiting, mild leukocytosis, and metabolic acidosis who have previous valvular heart disease or atrial fibrillation. Ultimately, selective low dose t-PA (5 to 10 mg) administration reduces the length of intestinal portion to be resected.     

Intraoperative streptokinase in the treatment of superior mesenteric artery embolisation. Case report.

Two patients were treated with peroperative intra-arterial infusion of streptokinase in addition to embolectomy to improve blood perfusion and reduce the magnitude of bowel resection in embolism of the superior mesenteric artery. Perfusion of the bowel improved considerably during and after streptokinase infusion thereby avoiding major intestinal resection in both patients.     

Embolism of the superior mesenteric artery. A clinical experience]

The Authors report their clinical experience in superior mesenteric artery embolism: 10 arterial embolisms (71%) collected from a series of 14 obstructions of the superior mesenteric artery. The main interval from the beginning of the symptomatology to hospital admission was 48 h. Laparotomy was performed in all ten patients; gangrenous bowel was resected in 2 and 2 had an embolectomy of the superior mesenteric artery without intestinal resection. The remaining 6 patients had laparotomy alone and died. The Authors emphasize the difficulty in recognizing the disease at an early stage and suggest to contemplate in patients at risk with a persistent abdominal pain, the possibility of a superior mesenteric artery embolism.     

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     

Surgical tactics in acute mesenteric artery occlusion

Operations were performed on 52 patients for acute mesenteric embolism, between 1980 and 1988. The average age of 48 of them was 75.8 +/- 7.3 years. Only four patients were below 60 years of age. Only exploratory laparotomy was possible in 20 cases, and all of these patients died. Six of eight patients (75 per cent) did not survive embolectomy from the superior mesenteric artery. Seven of twelve patients (58 per of eleven patients (27 per cent) died after embolectomy and resection of subtotal parts of the small intestine. Death occurred also to one patient with acute iliaco-mesenteric bypass. Hence, total mortality of all 52 patients amounted to 71.1 per cent. The mortality rate for 32 patients with attempted restitutional surgery amounted to 53.1 per cent, exploratory laparotomy unconsidered. This was certainly attributable to 73 per cent of survivors of embolectomy combined with removal of somewhat extended intestinal sections. Follow-up checks in short intervals of serum lactate have proved to provide reliable diagnostic parameters and means for postoperative appraisal with a view to making an informed estimate of changes of a second-look operation for acute intestinal ischaemia. The lactate mean value for mesenteric embolism was 8.88 +/- 4.43 mmol/l. However, lactate values were normal, between 1 mmol/l and 2 mmol/l, in acute abdominal processes with non-ischaemic causes and in cases of ischaemia of extremities.(ABSTRACT TRUNCATED AT 250 WORDS)     

肠系膜血管疾病的诊断与治疗效果：附13例分析

目的：探讨肠系膜血管疾病的早期诊断及治疗方法。 方法：回顾性分析2002年1月—2010年10月收治的13例肠系膜血管疾病（MVD）患者的临床资料。13例患者中,肠系膜上动脉栓塞（MAE）7例,肠系膜静脉血栓形（MVT）6例。 结果：13例患者均以急性腹痛就诊,分别行Doplex血管超声、CT、CTA、MRI检查,其中Doplex血管超声早期发现病变10例。3例患者接受非手术治疗;10例出现腹膜炎体征的患者行手术治疗,包括静脉切开取栓、Fogarty导管取栓、坏死肠管切除,术后均行了抗凝治疗。13例患者均恢复良好,顺利出院。 结论：MVD易与其他急腹症混淆,其诊断有赖于对该病的高度临床警觉性与针对性检查,早期诊断与积极处理是成功治疗该病的关键。     

Superior mesenteric artery embolism: Eighty-two cases

Eighty-two consecutive patients with superior mesenteric artery embolism were treated between 1966 and 1988. Abdominal pain was atypical or absent in 19 (23%) patients. Except for two instances of intraoperative embolism, emergency mesenteric arteriography was diagnostic in all cases. Seventeen patients were treated medically either because the site of embolism was peripheral, or because there were no life-threatening signs. Sixty-five patients underwent surgery, 31 for mesenteric infarction, and 34 for acute mesenteric ischemia without intestinal necrosis. Surgical treatment included 34 isolated embolectomies, 20 embolectomies associated with intestinal resection, two short segmental resections for limited necrosis of the small intestine, and nine exploratory laparotomies. Of the 34 patients operated on for acute mesenteric ischemia, 12 (35%) died. Of the 31 remaining patients operated on for intestinal infarction, 21 (68%) (p<0.05) died. The mean duration of ischemia before operation was 13 hours 20±6 min and 21 hours 24±24 min, respectively (p<0.05). Two patients (12%) receiving medical treatment died. This study confirms that survival is directly related to early diagnosis based on emergency mesenteric arteriography. Treatment is determined by clinical and roentgenographic criteria. Medical treatment is indicated in certain circumstances.Presented at the Annual Meeting of the Société de Chirurgie Vasculaire de Langue Française, Strasbourg, France, June 23–24, 1989.     

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.