急性肠系膜缺血性疾病的诊断与治疗

目的总结急性肠系膜缺血性疾病的早期诊治经验。方法回顾性分析1988—2005年间诊治的35例急性肠系膜缺血性疾病病人的临床资料。发生在肠系膜动脉30例，肠系膜静脉5例。主要临床表现为急性腹痛（94％）；51％的病人有血清酶谱异常。结果全部病例均通过手术得以证实。4例行肠系膜上动脉置管溶栓，15例行Fogarty导管取栓术，16例行肠管切除。总病死率为23％，肠管坏死病例病死率为50％，多例病人术后出现再灌注损伤。结论动态观察血清酶谱变化有助于该类疾病的早期诊断，对术后再灌注损伤要高度重视。

Diagnosis and treatment of acute mesenteric ischaemia

Objective To study diagnosis and treatment of acute mesenteric ischaemia.Methods Clinical data of 35 cases of acute mesenteric ischaemia admitted between 1988 and 2005 in Beijing Shijitan Hospital were analyzed retrospectively.Arterial occlusion was found in 30 cases and vein thrombosis in 5 cases.Acute abdominal pain was the important clinical presentation (94%).There were changed of enzymes in serum in 51% of cases.Results All lesions were identified by operations.Thrombolysis by percutaneous catheter in superior mesenteric artery was performed in 4 cases.Simple thrombectomy by fogarty catheter was performed in 15 cases.Nonviable bowel resection was performed in 16 cases.The mortality was 23% in total of cases and 50% in cases with bowel gaogrene. Reperfusion injury occurred in a few cases after operations.Conclusion It is beneficial for early diagnosis of acute mesenteric ischemia by examination of enzymes in serum.Reperfusion injury is another important feature of exacerbating intestinal damage.