急性小肠系膜缺血临床表现及外科处理

Acute mesenteric ischemia: clinical manifestation and surgical management

目的总结20例急性小肠系膜缺血病人的临床表现和治疗结果。方法分析自1994年8月至2004年9月间,我科共收治的20例急性小肠系膜缺血病人的临床表现及外科处理结果。结果急性剧烈的腹痛为其共同特点,其中18位病人有腹膜炎表现,13位病人有低血压休克表现;1例在入院3h后死亡外,19例切除坏死的小肠和相对应的肠系膜。病理检查及尸检证实:肠系膜上动脉栓塞3例(15%),肠系膜上动脉血栓形成5例(25%),肠系膜静脉血栓形成12例(60%)。术后切口感染2例,吻合口瘘2例,腹腔感染4例,肺部感染3例,急性肾衰1例,脑血管意外1例。术后24～72h内有4例因再次肠坏死再行部分小肠切除术。最终,治愈13例,死亡6例。结论急性小肠系膜缺血发病急、进展快,病情重。腹膜炎出现后,应立即行剖腹探查,并同时给予抗凝治疗。

Objective To analyze and summarize the clinical manifestation of patients with acute mesenteric ischemia. Methods Twenty patients with acute mesenteric ischemia were admitted to our hospital from August 1994 to September 2004 and their clinical data were analyzed. Results The symptom for all the patients was severe abdominal pain. 18 patients demonstrated peritonitis and 13 patients exhibited hypotension. Except that one patient died prior to operation, the other 19 patients underwent an emergent operative exploration. Necrotic intestines were resected. Subsequent pathological examination demonstrated that there was acute mesenteric artery embolism in 3 cases, acute mesenteric artery thrombosis in 5, and acute mesenteric vein thrombosis in 12. The postoperative complication included incisional infection in 2 patients, anamostosis fistula in 2 patients, abdominal infection in 4 patients, lung infection in 3, renal failure in 1 and brain stroke in 1. Four patients accepted the second operation on postoperative day 1 to day 3 owing to another attack of intestinal ischemia. At last, 13 patients were cured, and 6 died from the disease. Conclusions The acute mesenteric ischemia is a severe and life-threatening disease, and should be treated as soon as possible.