急性肠系膜动脉性缺血26例

Diagnosis and treatment of acute mesenteric artery ischemia:an analysis of 26 cases

目的:探讨急性肠系膜动脉性缺血的诊断及治疗.方法:回顾分析26例急性肠系膜动脉性缺血的临床特征、诊断、治疗及预后.结果:入院后确诊11例,其中:彩色多普勒超声6例,螺旋CT9例,血管造影5例.其余15例因血性腹水探查术中确诊.全身抗凝治疗4例,Fogarty导管取栓术后完全恢复5例,小肠部分切除8例,小肠大部及右半结肠切除7例,2次探查术2例.术后6mo内死亡6例.结论:超声可作为急性肠系膜动脉性缺血患者的初步检查,发现血性腹水者及早行剖腹探查术.早期诊断与治疗使降低肠系膜血管死亡率和致残率的关键.

AIM：To evaluate the diagnosis and treatment of acute mesenteric artery ischemia.METHODS：A total of 26 patients with acute mesenteric artery ischemia were included in the study.The clinical features,diagnosis,treatment and prognosis of these patients were retrospectively analyzed.RESULTS：Definite diagnosis was preoperatively established in 11 patients,of which 6 were diagnosed by color Doppler ultrasonography,9 by spiral CT,and 6 by digital subtraction angiography （DSA）.The remaining 15 patients with bloody ascites were diagnosed by exploratory laparotomy.Of all patients,4 received systemic anticoagulation,5 were subjected to Fogarty balloon catheterization for thrombus removal and completely recovered,8 underwent partial smallbowel resection,7 underwent subtotal small bowel and right-sided colon resection,and 2 underwent second-look operation.Six patients died in six months after operation.CONCLUSION：Ultrasound is considered as a first-line diagnostic technique for acute mesenteric artery ischemia.Exploratory laparotomy should be performed in patients with bloody ascites.Early diagnosis and treatment are key to decreasing the mortality and morbidity of acute mesenteric artery ischemia.