急性肠系膜血管闭塞时肠道的处理

Experience on the management of intestine during mesenteric vascular occlusion.

目的总结肠缺血和淤血时肠道的处理经验和教训。方法回顾性分析2001-2006年收治的5例肠系膜血管闭塞的诊治过程,重点探讨不同情况下如何缩小肠管的切除范围,减少并发症的发生。结果5例病人中,3例病人处理得当,结果满意。1例病人初次处理不当,再次行肠切除,病人治愈。1例转当地医院后行造口还纳术,1周后因小肠大出血而死亡。结论对于受累肠管范围较小的病例,应将受累肠管切除,保证吻合口愈合良好;对于肠管累及范围较大的病例,应尽可能保留生机可能恢复的肠管,采用肠造口的方法观察肠管活力,适时进行造口还纳。在处理肠管的同时,对肠系膜血栓的病人应进行取栓,术后抗凝治疗,避免血栓蔓延和复发。

Objective To summarize the management experiences of intestine during mesenteric vascular occlusion. Methods Five cases of intestinal ischemia or mesenteric venous thrombosis from 2001 to 2006 were retrospectively analyzed and a discussion was made on the avoidance of massive intestinal resection in different circumstances. Results Three of five patients were treated adequately with excellent results. 1 patient received inadequate intestinal resection, a relaparotomy and intestinal resection was made with satisfactory result. 1 patient was dead with intestinal bleeding. Conclusion For patients with minor area of mesenteric vascular occlusion,anastomosis should be established on the healthy intestine to avoid intestinal fistula. For patients with massive intestinal ischemia/congestion, care should be taken to avoid loss of too much intestine, enterostomy is helpful for the evaluation of intestinal viability and a planned reanastomosis to reestablish the continuity of the intestine is suggested. For patients with mesenteric thrombosis, thrombectomy and anticoagulant therapy are necessary to avoid further development of the thrombus.