急性肠系膜上动脉缺血的外科治疗

目的 探讨急性肠系膜上动脉缺血的外科治疗.方法 对1996-2010 年解放军总医院收治的40 例急性肠系膜上动脉缺血患者的临床资料进行回顾性分析.结果 本组40 例中肠系膜上动脉栓塞35 例,肠系膜上动脉血栓形成5 例.入院后7 例行球囊扩张支架植入术,33 例行急诊剖腹探查术,其中2 例行肠系膜上动脉取栓术,6 例行肠系膜上动脉取栓+ 坏死肠管切除术,2 例行人工血管旁路术,30 例行坏死肠管切除术.术后均行肝素等抗凝治疗.8 例死亡,总病死率20%.结论 对腹部剧痛且症状与体征分离,应警惕肠系膜上动脉缺血的可能.早期诊断、早期行肠系膜上动脉取栓术是提高治愈率的关键.

Surgical treatment of acute superior mesenteric artery ischemia

Objective To study the surgical treatment of acute superior mesenteric artery ischemia(AMAI).Methods Clinical data about 40 AMAI patients admitted to Chinese PLA General Hospital from 1996 to 2010 were retrospectively analyzed.Results Of the 40 AMAI patients enrolled in this study,35 were diagnosed as mesenteric artery embolism and 5 as mesenteric artery thrombosis.Of these patients,7 underwent balloon expansion stent implantation and 33 exploratory laparotomy(2 underwent resection of mesenteric artery thrombosis,6 resection of mesenteric artery thrombosis and necrotic intestinal canal,2 artificial blood vessel bypass,30 resection of necrotic intestinal canal).All patients received anti-coagulant therapy after operation.Eight patients died,with a total mortality of 20%.Conclusion AMAI should be suspected in a patient with acute abdominal pain and inconsistent symptoms and signs.Early diagnosis and prompt embolectomy are the key to improving its curative rate.