肠系膜上动脉狭窄致肠缺血坏死的诊断与治疗

Severe stenosis of the superior mesenteric artery causing intestinal ischemia necrosis: report of 14 cases and review of the literature

目的分析肠系膜上动脉硬化狭窄致肠缺血坏死的临床特点,探讨其诊断与治疗。方法对辽宁医学院附属第一医院2006～2011年收治的肠系膜上动脉硬化狭窄致肠缺血坏死患者14例临床资料进行回顾性分析。结果 14例均手术治疗,其中8例行小肠部分切除加肠系膜上动脉探查,1例死亡。6例仅行坏死肠管切除,3例死亡。结论对于老年伴长期吸烟史或慢性胃肠道症状及消瘦病史患者,突发腹部剧痛应高度警惕肠系膜上动脉硬化狭窄致肠缺血坏死可能。早期行全腹CT或肠系膜上动脉彩色多普勒检查可提示诊断。术中应积极探查肠系膜上动脉使血管再通,快速恢复缺血肠管血供,尽可能保留正常肠管避免短肠综合征发生。

【Objective】To analyse the features of clinical manifestation of superior mesenteric artery stenosis intestinal necrosis,and to discuss the diagnosis and treatment.【Methods】14 cases of superior mesenteric artery stenosis intestinal necrosis between 2006 and 2011 were retrospectively analyzed.【Results】All cases were treated with operation in which 8 cases of partial small bowel resection and superior mesenteric artery exploratory,7 were cured and 1 died.In 6 cases with single necrotic bowel resection,3 died.【Conclusions】The aged with long history of smoking or chronic gastrointestinal symptoms and weight loss who appear acute abdominal pain,should be highly aware of the intestinal necrosis caused by superior mesenteric artery stenosis.Multi-slice CT or superior mesenteric vascular color Doppler should be used for the diagnosis before operations.Exploration of the superior mesenteric artery in order to make vascular recanalization early.Fast recovering ischemic intestine blood supply so as to prevent it from short bowel syndrome.