急性肠系膜上动脉闭塞性疾病的临床特点及诊治体会

目的：探讨急性肠系膜上动脉闭塞性疾病的临床特点及诊治方法。方法：回顾性分析天津医科大学总医院2003年11月至2011年3月收治的36例该病患者的临床资料。结果：本组36例患者，急性栓塞26例，慢性闭塞基础上的急性血栓形成10例；手术治疗27例，行单纯肠系膜上动脉取栓术4例，单纯坏死肠段切除术10例，肠切除及取栓术11例，肠切除及血管旁路术1例，肠切除、取栓及血管旁路术1例，治愈13例，死亡14例；保守治疗9例，好转7例，死亡2例；总死亡率44.4%。20例随访期间，术后再发本病者1例，经肠切除及肠系膜上动脉取栓术治愈，余经彩超证实均无再发肠系膜上动脉闭塞迹象。结论：对高度怀疑本病者应尽早行CTA或DSA检查，早期改善动脉供血、综合手段重建肠系膜上动脉是提高存活率和治愈率的关键。

Clinical characteristic and diagnosis experience of acute superior mesenteric artery occlusive disease

Objective: To explore the clinical characteristic , diagnosis and therapy of acute superior mesenteric artery occlusive disease. Methods: Retrospectively analyse the clinical data of 36 cases of inpatients with acute superior mesenteric artery occlusive disease in Tianjin Medical University General Hospital from Nov. 2003 to March. 2011. Results: Among the 36 cases, acute superior mesenteric artery embolism 26 cases, acute superior mesenteric artery thrombosis based on chronic superior mesenteric artery occlusion 10 cases. 27 cases by surgical therapy: simple embolectomy 4 cases; simple resection of necrotic intestine 10 cases; resection of intestine and embolectomy 11 cases; resection of intestion and artery bypass operation 1 case ;resection of intestine, embolectomy and artery bypass operation 1 case. 13 cases healed , 14 cases died. Expectant treatment 9 cases, 7 cases got better, 2 cases died, general mortality rate 44.4%. During the follow-up period of 20 cases, 1 post-operation case recurred, and cured by resection of intestine and embolectomy, there were no evidence of recurrence through B ultrosound in other cases. Conclusion: The patients of disease highly-suspected should be given the CTA or DSA as soon as possible, improving artery blood early and reconstructing superior mesenteric artery plays a crucial part in improving survival rate and cure rate.