外科治疗肠系膜上动脉栓塞的临床分析

Clinical analysis of surgical treatment for superior mesenteric artery embolism

目的探讨急性肠系膜上动脉栓塞早期诊断及取栓的临床疗效。方法回顾性分析1999-2005年,21例肠系膜上动脉栓塞的临床资料。根据患者从发病到手术间隔的时间长短分为2组:Ι组为发病后6h内进行手术治疗者,9例;Ⅱ组为发病6h后进行手术治疗者,12例。所有取栓患者术中在动脉内灌注尿激酶,术后应用肝素抗凝。结果取栓和局部应用尿激酶后,观察30min,发现12例小肠血运恢复正常,其中Ι组9例全部恢复,Ⅱ组有3例恢复。Ι组无行肠切除者;Ⅱ组中有9例(75.0%)进行了肠切除,4例为局部切除,5例为长段肠管切除。Ι组病死率为0,Ⅱ组为41.6%。结论早期诊断及及时治疗有助于减少肠坏死及降低病死率。

Objective To assess the early diagnosis of acute mesenteric artery embolism and the clinical outcome of embolectomy. Methods The clinical data of 21 patients with superior mesenteric artery embolism between 1999 and 2005 were retrospectively analyzed. The patients were divided into two groups according to the operation time interval after onset of symptoms. Group Ⅰ （ n = 9 ） ： patients were operated on in the first 6 hours after onset of symptoms ; group Ⅱ （ n = 12 ） ： patients were operated on more than 6 hours after onset. Urokinase administration directly into the superior mesenteric artery was an additional procedure during the embolectomy, and postoperative heparin anticoagalation was used in all patients. Results The circulation of the intestine returned to normal in 12 patients （ all of the 9 patients in group Ⅰ and 3 patients in group Ⅱ ） 30 minutes after embolectomy and administration of urokinase. Segmental intestinal resection was necessary in 4 patients and extended intestinal resection in 5 patients in group Ⅱ. The motality of group Ⅱ was 41.6 % and 0 in group Ⅰ. Conclusions Early recognition and prompt treatment can reduce the incidence of bowel necrosis and mortality rate of patients with superior mesentevic artery embolism.