急性肠系膜缺血性疾病42例临床分析

Early diagnosis and treatment of acute mesentric ischemia for 42 cases in single center

目的探讨急性肠系膜缺血性疾病（acute mesenteric ischemia，AMI）的早期诊断和治疗。方法回顾性总结天津市人民医院普通外科2007年6月到2011年11月间42例AMI患者的临床资料，所有患者均经cT和（或）血管造影和（或）手术诊断为AMI，其中急性肠系膜上动脉闭塞（AOMI）32例，肠系膜上静脉血栓形成（SMVT）9例，非闭塞性急性肠系膜缺血（NOMI）1例。采用早期介入治疗和应用损伤控制外科原则的综合治疗，生存患者均在门诊随访6个月以上。结果（1）32例AOMI患者经全身抗凝治愈4例；介入治疗19例，其中单纯介入治疗治愈10例，介入失败后手术5例，未手术死亡3例，术后再介入治疗治愈1例；直接手术治疗8例；放弃治疗1例。（2）9例SMVT患者中，全身抗凝治疗后好转2例；介入治疗6例，其中单纯行介入治疗后治愈1例，介入失败1例行手术治疗治愈，4例考虑肠坏死先行手术后再次介入治疗治愈；1例患者未治疗死亡。（3）术中应用损伤控制原则延迟关腹8例。本组总体病死率23．8％（10／42）。介入治疗的26例患者中，死亡4例，病死率15．3％；延迟关腹者8例，死亡1例，病死率1／8。结论早期诊断是降低AMI病死率的关键，早期介入治疗和应用损伤控制原则的综合治疗可以明显降低AMI的病死率。

Objective To investigate the early diagnosis and treatment of acute mesenteric ischemia. Methods Forty-two patients with acute mesenteric ischemia from June 2007 to November 2011 were reviewed retrospectively. All patients were diagnosed with DSA and （or） CT and （or） surgery. In this group, there were 32 cases of acute occlusion of meseteric ischemia （AOMI）, 9 cases of superior mesenteric venous thrombosis （SMVT） and 1 case of non-occlusive mesenteric ischemia. The patients were treated using comprehensive treatment including early intervention treatment and application of the principle of damage control. The survival of all patients was followed up for 6 months or more in outpatient. Results （1） Of the 32 AOMI cases, 4 cases healing by systemic anticoagulation; The 19 cases received interventianal treatment, including 10 cases received simply interventional treatment, surgery after the failure of intervention in 5 cases, 3 patients died without surgery and postoperative interventional treatment one cases were cured ; Eight cases received surgery treatment ; One case gave up. （2） Of the 9 SMVT cases, 2 cases healing by systemic anticoagulation; The 6 cases received interventianal treatment, including 1 cases received simply interventional treatment, surgery after the failure of intervention in 1 cases, 4 cases to consider intestinal necrosis received interventional treatment again after surgery; One patient died without treatment. （3） Eight cases received delay abdomen close treatment with the princple of damage control surgury. The overall mortality rate of 23.8% （10/42）. Interventional treatment of 26 cases, 4 deaths, a mortality rate of 15.3% ; The abdomen delayed close of 8 cases, 1 death. Conclusions The results show that early diagnosis and treatment is critical to reduce AMI mortality. Comprehensive treatment of early intervention treatment and application of the principle of damage control can significantly reduce the mortality of AMI.