肠系膜血管疾病所致急腹症17例诊断与处理

目的探讨肠系膜血管疾病所致急腹症的早期诊断及处理方法。方法对1991年1月-2006年6月收治的17例肠系膜血管疾病所致急腹症的临床资料进行回顾性分析。结果MAE 5例（29.4%）,MAT3例（17.6%）,MVT 9例（52.9%）,以中老年患者为多见,常并存心脏、血管疾病。临床表现差异较大,容易漏诊、误诊。最常见的临床表现为腹痛（89.3%）,最可靠的诊断方法为肠系膜血管造影（100%）。平均确诊时间13 h,17例中确诊11例,急诊手术治疗8例,保守治疗6例,介入治疗3例。治愈13例,死亡3例,致残1例。结论重视病史的全面采集,坚持正规的体格检查程序,严密观察病情,正确的临床逻辑思维,恰当的辅助检查,积极介入治疗与剖腹探查是早期诊断和成功治疗该病的关键。

Diagnosis and management of acute abdomen caused by mesenteric vascular diseases:report of 17 cases

Objective To investigate early diagnosis and management of acute abdomen of mesenteric vascular diseases.Methods The clinical data of 17 cases of acute abdomen caused by mesenteric vascular diseases from January 1991 to June 2006 were collected and analyzed retrospectively.Results 5(29.4%)Mesenteric artery embolism (MAE),3 patients(17.6%)mesenteric artery thrombosis(MAT),9 patients(52.9%)mesenteric venous thrombosis (MVT)Most of the patients were aged and accompanied with cardiovascular diseases as a basis of acute vascular abdomen.The clinical manifestations were individualized significantly.The diagnoses were mistaken or lost much more easily.Abdominal pain was the common symptom(89.3).The most valuable examination was selective mesenteric arteriography.in this studied group,the average time of confirming the diagnosis was 13 hours.Among the 17 patients,11 cases were definitely diagnosed.8 cases received emergency operation,7 cases were treated non-operatively,3 cases received catheter-directed thrombolysis,13 cases recovered,two patients died and one was disabled.Conclusion The keys to early diagnosis and success treatment of acute vascular abdomen are pay more attention to the history collecting, correct sequence of physical examination,observing patients frequently and closely,logical intellection and exact adjuvant examinations,aggressive treatment mainly including interventional and surgical treatment.