急性肠系膜上动脉闭塞血运重建术38例回顾分析

Revascularization in Superior Mesenteric Artery Occlusion:Retrospective Analysis of 38 Cases

目的探讨急性肠系膜上动脉闭塞的诊断、不同术式治疗和预后。方法获得随访的38例急性肠系膜上动脉闭塞患者,多表现为急性腹痛,术前均经CT血管造影诊断为肠系膜上动脉闭塞。综合分析患者病因、病情和辅助检查,采用置管溶栓、导管取栓、自体静脉或人工血管旁路转流术、球囊扩张支架植入等个体化的外科治疗方案进行肠系膜上动脉的血运重建术。伴肠坏死的患者行肠切除术。结果术后患者均随访半年。30例患者术后血运重建良好,彩超复查见肠系膜上动脉血流通畅。术后出现短肠综合征4例,3例死亡;肠瘘2例,1例死亡;多器官衰竭/脓毒症3例,2例死亡;再灌注损伤6例;原伴发疾病加重6例,2例死于急性心功能衰竭。术后并发症总出现率为55.2%,术后总死亡率为21.1%。结论术前选择合适手段及早明确诊断,并尽快应用个体化的血运重建术能显著改善急性肠系膜上动脉闭塞患者的预后。

Aim To discuss and evaluate the diagnosis,differenis surgical techniques and prognosis of superior mesenteric artery occlusion（SMAO）. Methods 38 cases of acute superior mesenteric artery occlusion were treated with individualized surgical methods.Acute abdominal pain was the important clinical presentation.All the patients were diagnosed as SMAO by computed tomography arteriography（CTA） before treatment.According to individual condition,38 patients accepted revascularizations including transcatheterizing thrombolysis,thromboembolectomy,ballon dilatation and stent implant,autologous vein or vascular prosthesis bypass/transplantation and resection of necrotic bowel respectively. Results Incision healed by first intention in all patients were followed up 6 months.The circulation of the intestine returned to normal in 30 patients by reexamination of color doppler ultrasonography.4 cases developed short-gut syndrome after operation and 3 cases died,and 2 cases developed intestinal fistula with death of 1 case;Severe infection and multiple organ failure was found in 3 patients and 2 cases died;And there were 6 patients with reperfusion injury,and 6 patients with deterioration of the primary affection and 2 of them died of heart failure.The overall incidence of postoperative complication was 55.2% and the overall mortality rate was 21.1%. Conclusion Early recognization by appropriate examination and early treatment with individualized surgical methods will improve the prognosis of SMAO.