62例急性肠系膜上动脉栓塞的诊断和治疗

Diagnosis and treatment of acute superior mesenteric artery embolism of 62 cases

目的探讨急性肠系膜上动脉栓塞的临床表现及早期诊断和治疗方法。方法回顾性分析62例急性肠系膜上动脉栓塞患者的临床资料。结果术前确诊22例(35.5%)。62例患者均行肠系膜上动脉切开取栓,58例患者行坏死肠管切除术,其中35例患者行多次肠管切除术。术后16例患者死亡(25.8%)。术后随访3～24个月。结论肠系膜上动脉栓塞误诊率高,病死率高。对心律失常特别是房颤、心脏瓣膜病及既往有急性动脉栓塞病史患者突发剧烈腹痛,应警惕肠系膜上动脉栓塞可能。肠系膜上动脉切开取栓是治疗急性肠系膜上动脉栓塞缩小肠管切除范围有效方法。

Objective To study clinical features and early diagnosis and treatment of acute superior mesenteric artery embolization. Methods Retrospectively analyze the data of 62 patients with acute superior mesenteric artery embolism in the Pingdingshan traditional Chinese medicine Hospital from January 2009 to January 2012. Results Preoperative diagnosis of the 22 patients was precise, preoperative diagnosis rate was 35.5%. All the 62 patients underwent superior mesenteric artery thromboembolectomy,58 patients underwent resection of the partly necrotic bowel,among them 35 patients underwent resection of the enteron of many times. Postoperative 16 patients died a mortality rate of 25.8%. The patients were followed up 3 months to 2 years postoperatively. Conclusion The misdiagnosis rate and mortality rate of acute superior mesenteric artery embolization were high. We should be vigilant the mesenteric artery embolization for the patients who with arrhythmia especially atrial fibrillation, heart valve disease and have a history of acute artery embolization along with sudden onset severe abdominal pain. Underwent superior mesenteric artery thromboembolectomy for superior mesenteric artery embolization is effective methods and can narrow acute bowel resection range.