肠系膜血管疾病术后肠道并发症防治

Prevention and management of intestinal complications after mesenteric occlusive disease surgery

肠系膜血管疾病是造成肠缺血和肠切除的重要原因,由于缺血范围不稳定,微血栓持续蔓延会导致肠缺血范围不断扩大,同时术后的感染性休克和再灌注损伤极易导致残留肠管受损,因此,应慎重选择一期肠切除吻合术。对于缺血范围不易确定或生命体征不稳定的病人,应重视应用损伤控制理念,一期手术将坏死肠管切除,疏通大血管,术后积极溶栓抗凝,待肠管血供范围稳定后再行造口还纳。肠吻合口缺血性并发症的再手术难度较大,术前应进行充分的思想准备和围手术期处理,避免再次手术损伤残留的健康肠管,导致短肠综合征。

Mesenteric occlusive disease is one of the most important causes of massive intestinal resection. The range of intestinal necrosis may vary depending on the severity and management of the disease. The one stage resection and anastomosis should be used with caution to avoid ischemia and continuing necrosis of the remnant intestine, which may bring about high morbidity and mortality. Damage control surgery with emergency resection of the necrotic intestine and thrombolectomy is the main task of 1st stage operation, after which anticoagulation, thrombolysis and antioxidation therapy together with fluid resuscitation should be followed. Definite surgery should be performed when patients are hemodynamically stable and intestinal viability ensured, which usually occur in 24-48h. Relaparotomy for ischemic intestinal anastomosis is very difficult technically demanding comprehensive perioperative preparation. Special care should be given to avoid further damage to the residue intestine to result in short bowel syndrome.