急性肠系膜动脉栓塞早期外科治疗必要性

Surgery of acute mesenteric artery embolism:the earlier the better

急性肠系膜动脉栓塞(acute mesenteric artery embolism,AMAE)是一种临床上相对少见的急重性血管外科疾病,通常是由栓子脱落或局部动脉硬化血栓形成而引发的。起病急、进展快、易误诊、病死率高是此病的主要特点。此类病人多有复杂的基础疾病,短时间发生的部分或全小肠功能障碍或坏死是此病预后不良的主要原因。早期诊断、早期药物干预或手术解除肠系膜动脉闭塞状态恢复肠道血运,尽可能多地保留未坏死肠管是降低病死率和提高生活质量的首要手段,近年来开展的开放手术和腔内治疗均是在这一共识的基础上开展的。长期的临床工作显示,目前对AMAE行开放手术普遍偏晚,腔内治疗手段及疗效也不尽人意,应鼓励外科医生抓准手术黄金时间点,更加积极有效地救治,以免待病人后期大面积肠坏死及病情累及多器官功能不全时再手术。

Acute mesenteric artery embolism （AMAE） is a clinically rarely acute severe vascular surgical disease，usually caused by emboli or thrombosis，partially caused by arteriosclerosis. Acute onset，rapid progression，misdiagnosed and high mortality are the main features of the disease. Such patients have a complex underlying disease，short-term occurrence of section or all of the small intestine dysfunction or necrosis is the main reason for poor prognosis. Early diagnosis and early medical or surgery intervention to remove the superior mesenteric artery occlusion state and restore intestinal blood flow，and conserve not necrotic bowel as much as possible is to reduce mortality and improve quality of life of patients. Long-term clinical work confirmed that occasion of open surgery for AMAE was generally partial late，and efficacy of endovascular treatment is less than satisfactory. It should encourage surgeon to grasp surgery gold points，perform more active and effective treatment of AMAE in order to make patient avoid suffering from a large area of intestinal necrosis and hazard multiple organ dysfunction then seek surgery.