急性肠系膜上动脉栓塞的外科治疗

Surgical Treatment of Acute Superior Mesenteric Artery Embolism

目的：探讨急性肠系膜上动脉栓塞的诊断方法和治疗原则。方法：13例病人中10例病程在12h内，采用Fogaty导管取栓并配合药物抗凝、溶栓治疗：3例病程在24h以上，术中发现肠管坏死，行肠管切除术。结果：3例肠坏死者术后5d、7d、9d因原发疾病严重并多器官功能衰竭而死亡，10例治愈。1～5年随访，3例死于心脏病，7例均未再发生肠系膜栓塞。治愈率53．8％，死亡率46.2％。结论：痉挛性腹痛、器质性心脏病、胃肠道排空异常是本病早期诊断的主要临床特点。

Objective To study the experience in diagnosis and treatment of acute superior mesenteric artery embolism （SAME）. Methods There were thirteen cases of SAME diagnosis confirmed. Ten cases of them were explored as SAME in 12 hours and with a Fogaty conduit pipe to remove the thrombus and anticoagulation and thrombolytic used. These cases who were detected as SAME patients in the course of 24 hours, were found intestinal necrosis during surgery, and so thrombectomy and intestine resection were done. Results These three patients with intestinal necrosis died of primary atrial fibrillation, while the remaining seven patients had no more SAME during the 1-5 years follow-up. The cure rate was 53.8 percent and the mortality was 46.2 percent. Conclusion Spasmodic abdominal pain, organic heart disease and gastrointestinal tract emptying anomalies are the main clinical feature of early diagnosis of the disease. Thrombectomy timely surgical treatment is effective treatment means.