急性肠系膜上动脉栓塞患者术式选择的临床研究

A clinical study on the choice of operative methods in patients with acute superior mesenteric artery embolism

目的探讨急性肠系膜上动脉栓塞(SMAE)患者术式选择的临床研究。方法选取2009年12月至2019年12月大庆油田总医院收治的急性SMAE患者31例。术前所有患者均采用腹痛数字分级评分法(NRS)对腹部疼痛等级进行判定,同时标注患者是否存在腹膜炎,当NRS>6和(或)腹膜炎患者采取开腹手术,NRS≤6且无腹膜炎患者采取介入手术治疗。统计患者好转及死亡人数,并比较不同临床结局患者的临床资料。结果31例急性SAME,23例患者NRS>6(合并腹膜炎患者9例,无腹膜炎患者14例),19例采取开腹手术,15例好转出院,4例死亡;4例采取介入手术,2例好转出院,2例死亡。8例患者无腹膜炎且NRS≤6,3例开腹手术,5例介入手术,均好转出院。术后好转25例,死亡6例,不同临床结局患者的临床资料比较,差异无统计学意义。结论NRS>6且合并腹膜炎者首选开腹手术,NRS≤6且无腹膜炎者选择介入治疗;对于NRS>6但未合并腹膜炎体征的患者,依据术者对两类术式的掌握程度选择最佳的手术方式。

Objective To explore the clinical study of the choice of operative methods in patients with acute superior mesenteric artery embolism(SMAE).Method From December 2009 to December 2019,31 patients with acute SMAE were selected from Daqing Oilfield General Hospital.Before the operation,all patients were evaluated by the numerical rating scale(NRS)of abdominal pain,and the presence of peritonitis was also marked.When the NRS>6 and/or peritonitis patients were treated by open surgery,the patients with NRS≤6 and no peritonitis were treated by interventional surgery.The number of patients improved and died was counted,and the clinical data of patients with different clinical outcomes were compared.Result 31 cases of acute SAME,23 cases of NRS>6(9 cases with peritonitis,14 cases without peritonitis),19 cases of open surgery,15 cases of improved discharge,4 cases of death;4 cases of interventional surgery,2 cases of improved discharge,2 cases of death.8 patients had no peritonitis and NRS≤6,3 patients underwent laparotomy and 5 patients underwent interventional operation,all of which improved and discharged.There was no significant difference in the clinical data of 25 cases of improvement,6 cases of death and patients with different clinical outcomes.Conclusion The patients with abdominal pain NRS>6 and peritonitis are the first choice for open surgery,and the patients with abdominal pain NRS≤6 and without peritonitis are the first choice for interventional therapy;for the patients with NRS>6 but without peritonitis signs,the best operation method is selected according to the degree of mastering the two types of operation.