急性肠缺血治疗策略探讨

目的探讨急性肠缺血的病因、诊断和治疗方法的选择。方法对2008年1月～2011年7月本科室收治的21例急性肠缺血患者的临床资料进行回顾性分析。肠系膜上动脉(SMA)血栓性闭塞16例,其中中心型9例,周围型2例,混合型5例,合并SMA硬化斑块7例;孤立性SMA夹层5例。结果中心型9例:5例行取栓,其中2例行小肠部分切除;导管溶栓4例,溶栓后支架置入3例,死亡1例,因小肠系膜缘出血行小肠部分切除1例。混合型5例:行剖腹探查肠切除3例,死亡1例,术后发生短肠综合征1例;2例行导管溶栓,其中1例死于心肌梗死,另1例辅以支架置入。周围型2例:药物溶栓1例,导管溶栓、碎栓1例,均成功。孤立性SMA夹层支架治疗3例,保守治疗成功2例。结论 SMA主干夹层病变首选保守治疗,如果症状不缓解,应积极治疗,以腔内治疗为主;急性肠缺血SMA主干栓塞,首选手术取栓;有时短段主干血栓形成或栓塞,也可以采用导管溶栓,必要时辅以支架。

Therapeutic strategy for the treatment of acute intestinal ischemia

Objective To investigate the etiology, diagnosis and treatment strategy of acute intestinal ischemia. Methods From January 2008 to July 2011, the clinical data of 21 patients with acute intestinal ischemia were analyzed retrospectively. Thrombotic obliteration in superior mesenteric artery (SMA) was observed in 16 cases, among which there were 7 cases complicated with arteriosclerosis obliterans in SMA. These patients were divided into 3 types, including 9 cases of central type, 2 cases of peripheral type and 5 cases of mixed type. The other 5 cases was occurred isolated dissection in SMA. Results Five cases of central type underwent thrombectomy, while 2 cases also underwent segmental bowel resection among them. Transcatheter thrombolysis was administrated in the other 4 cases of central type, including 3 patients underwent stent deployment and 1 case underwent intestinal resection because of mesentery hemorrhage and 1 case died. Three cases of mixed type underwent bowel resection, including 1 case was complicated with short bowel syndrome after surgery, and 1 case died after surgery. Transcatheter thrombolysis was administrated in 2 cases of mixed type, including 1 case underwent stent deployment and 1 case died of myocardial infarction. Systemic thrombolysis was administrated in 1 case of peripheral type,and transcatheter thrombolysis combined with interventional fragmentation was successfully performed in the other case. Stents were successfully deployed in 3 patients with dissection in the SMA, while conservative treatment was administrated in another 2 patients. Conclusion Conservative treatment is recommended as the first choice of treatment for dissection in the SMA. Intervention treatment will be performed actively if clinical symptoms do not improve. Thrombectomy is the first choice for patients with thromboembolism in the SMA. Transcatheter thrombolysis combined with stent deployment is feasible for patients with short-segment thromboembolism in the SMA.