肠系膜动脉栓塞和血栓形成荟萃分析

目的总结分析肠系膜动脉栓塞(MAE)和血栓形成(MAT)的诊断与治疗现状。方法在中国期刊全文数据库中检索,从1994年至2006年共有个案病例报道83篇,提取其临床资料进行总结分析。结果累计111例确诊为MAE(54.9%)和MAT(45.1%)。其中87.4%的患者是通过剖腹探查或尸体解剖确立诊断,12.6%依靠影像学手段确诊。误诊率61.3%。46.8%的患者有心房颤动的病史。92.8%的病变位于肠系膜上动脉,4.5%位于肠系膜上动脉和肠系膜下动脉。空肠或回肠坏死15.2%(14/92),空肠加回肠坏死39.1%(36/92),空肠、回肠和结肠坏死38.0%(35/92)。治疗:肠系膜动脉内溶栓或抗凝7例(6.3%),Fogarty导管取栓或术中溶栓18例(16.2%),手术切除坏死肠管76例(68.5%);病死率60.6%。结论MAE和MAT误诊率和病死率均高,应提高对该类疾病的认识和临床诊疗水平。

Meta-analysis of mesenteric arterial embolism or mesenteric arterial thrombosis

Objective To summarize the clinical characteristics of mesenteric arterial embolism (MAE) and mesenteric arterial thrombosis (MAT), and to clarify the diagnosis and treatment status of MAE and MAT in China. Methods A retrospective analysis of 111 cases suffering from MAE or MAT was performed. Data of these cases were collected from Chinese Journal Full-text Database from 1994 to 2006. Results There were 61 cases (54.9%) with MAE and 50 cases (45.1%) with MAT. Fifty-two patients (46.8%) had arterial fibrillation. Ninety-seven cases (87.4%) were diagnosed by exploratory laparotomy or autopsy, and 14 cases (12.6%) by imageology. Embolism or thrombosis in superior mesenteric artery (SMA) accounted for 92.8%, 4.5% in SMA plus inferior mesenteric artery. 15.2%(14/92) necrosis were located in jejunum or ileum, 39.1%(36/92) in jejunum and ileum, 38.0%(35/92) in jejunum, ileum and colon. Thrombolysis or anticoagulation in artery were operated in 7 cases(6.3%). Extraction of embolism or thrombosis in operation were implemented in 18 cases(16.2%). Intestinal resection were finished in 76 cases(68.5%). Sixty-eight patients (61.3%) were misdiagnosed. Sixty-three cases (60.6%) died. Conclusion The manifestation of MAE or MAT is quite complicated and changeable, so that many cases are misdiagnosed. The clinic and image characteristics of MAE and MAT have not been well known by doctors.