急性血运性肠梗阻的诊治(附35例报告)

Diagnosis and treatment of acute mesenteric vascular obstruction in 35 cases

目的提高对急性血运性肠梗阻的早期诊断和综合治疗水平。方法回顾性分析35例急性血运性肠梗阻患者的临床资料。结果所有患者均行抗凝治疗,合并手术治疗22例,该组病例总死亡率为28.6%(10/35),造成血运障碍的原因包括肠系膜上动脉栓塞9例,死亡4例;肠系膜上动脉血栓形成6例,死亡2例;肠系膜静脉血栓形成20例,死亡4例。CT、MRI以及选择性肠系膜血管造影检查的确诊率分别为72.2%(13/18)、77.8(%7/9)和90.9(%10/11)。结论急性血运性肠梗阻早期诊断困难,一旦延误治疗则死亡率较高。CT和MRI检查对确诊有辅助意义,选择性肠系膜血管造影是诊断的较特异方法。

[Objective] To improve the early diagnosis and treatment of acute mesenteric vascular obstruction. [Methods ] The clinical materials of 35 cases surgically treated patients with acute mesenteric vascular obstruction were analyzed retrospectively. [Results] All the patients were treated by anticoagulation and 22 cases were treated by operation. The total mortality rate of the group was 28.6% （10/35）. There were 9 cases of superior mesenterie artery embolism （4 dead）, 6 cases of superior mesenteric artery thrombosis （2 dead）, and 20 cases of mesenteric venous thrombosis （4 dead）. The diagnostic rate of CT, MRI and selective angiography was 72.2% （13/18）, 77.8% （7/9）, 90.9%（10/11）, respectively. [Conclusion] It is difficult of early diagnosis for acute mesenteric vascular obstruction. The mortality rate would be high if the diagnosis and treatment is delayed untial intestinalnecrosis has occurred. CT, MRI are helpful for diagnosis, but the selective mesenterlc angiography is the most special method for diagnosis of the disease.