急性肠系膜上动脉栓塞的诊断与治疗

Diagnosis and treatment of acute superior mesenteric artery embolism

目的探讨急性肠系膜上动脉栓塞的诊断与治疗。方法对近1 0年收治的急性肠系膜上动脉栓塞患者2 2例临床资料进行回顾分析。结果术前确诊率为7 7.3%,2例非手术治疗者均死亡(病死率1 0 0.0%)。2 0例经手术治疗,其中5例行单纯坏死肠管切除,端端吻合术,3例死亡(病死率6 0.0%);1 5例行肠系膜上动脉取栓加坏死肠管切除,5例死亡(病死率3 3.3%)。总病死率为4 5.5%。结论对于有器质性心脏病的患者,突然出现腹部疼痛,应警惕肠系膜上动脉栓塞的可能。CTA是诊断急性肠系膜上动脉栓塞的有效手段。早诊断、早期行肠系膜上动脉取栓术是提高治愈率的关键。

Objective To discuss the manifestations, diagnosis and management of acute superior mesenteric artery embolism. Methods The clinical data of 22 cases of acute superior mesenteric artery embolism admitted in our hospital in recent 10 years were analyzed retrospectively. Results The preoperative diagnostic rate was 77. 3% . Among them, 2 cases who refused operation died（ 100% ） ; 20 cases were subjected to operation, in whom 5 cases underwent simple resection of necrotic bowel and 3 of them died （60 % ） , while 15 cases were subjected to resection of necrotic bowel after removal of the embolus and 5 of them died （ 33.3 % ） . The overall mortality was rate 45.5 % . Conclusions Acute superior mesenteric artery embolism should be suspected in every patient with sudden abdominal pain, especially in those who have organic cardiac disease. CTA is an effective method for diagnosis of acute superior mesenteric embolism. Early diagnosis and prompt embolectomy are the key points to improve the therapeutic effects.