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。

Surgical Treatment for Acute Superior Mesenteric Arterial Thrombosis

Objective To summarize surgical treatment for acute superior mesenteric arterial thrombosis. Method 32 cases of acute superior mesenteric arterial thrombosis admitted from January 1990 to December 2005 underwent removal of thrombosis by incising superior mesenteric artery (SMA), and the visceral vascular comorbidity were treated simultaneously. Result 30 cases cured, 2 cases died of heart and respiratory failure. No recurrence and stricture were observed 1 year postoperatively, SMA was patent and collateral was normal as demonstrated by CTA. With 2 to 15 years follow-up in 30 cases, no stricture or recurrence observed in 23 cases, 7 cases died of myocardial or intracranial hemorrhage. Conclusion Early diagnosis and surgical treatment together with treatment of comorbidity can significantly improve the prognosis of acute superior mesenteric arterial thrombosis.