急性肠系膜血管闭塞51例临床诊断和治疗

A study of clinical diagnosis and management in 51 cases of acute mesenteric vascular occlusion

目的探讨急性肠系膜血管闭塞(AMVO)的早期诊断及治疗。方法回顾性分析51例AMVO的临床特点。结果肠系膜上动脉栓塞(SMAE)33例,肠系膜上动脉血栓形成(SMAT)7例,肠系膜上静脉血栓形成(SMVT)11例。入院即诊断为SMAE的仅有16例;手术27例,非手术治疗6例;死亡20例,治愈13例。入院即诊断为SMAT的仅有4例;手术4例,介入治疗1例,非手术治疗2例;死亡4例,存活3例。入院即诊断为SMVT的有8例;手术3例,介入治疗2例,非手术治疗6例;死亡3例,存活8例。结论早期诊断、积极行介入治疗与剖腹探查为主的外科治疗是提高AMVO疗效的关键。

Objective To investigate themethods-of early diagnosis and management of the acute mesenteric vascular occlusion （AMVO）. Method The clinical data of 51 cases of AMVO were retrospectively reviewed. Diagnosis proce- dure, surgical management and prognosis were analyzed. Result The cause of AMVO was mesenteric artery embolism （SMAE） in 33 patients, mesenterie artery thrombosis （SMAT） in 7 patients, and mesenterie venous thrombosis （SMVT） in 11 patients. In 33 cases of SMAE, 16 cases were definitely diagnosed in the early stage. 6 cases were treated nonoperatively ,27 cases received emergency operation. 13 cases were recovered and 20 cases died. In 7 cases of SMAT,4 cases were definitely diagnosed. 4 cases received emergency operation, 1 case received interventional treatment ,2 cases were treated nonoperatively,3 cases were recovered and 4 cases died. In 11 cases of SMVT,8 ca- ses were definitely diagnosed. 6 cases were treated nonoperatively,2 cases received catheter directed thrombolysis,3 cases received operation. 8 cases were recovered and 3 cases died. Conclusion Early diagnosis before intestinal in- farction and aggressive treatment mainly including interventional and surgical management are the key to better prog- nosis in AMVO.