急性肠系膜上动脉栓塞小肠广泛坏死七例治疗经验

Experience in the management of extensive small bowel necrosis from acute superior mesenteric arterial embolism: report of 7 cases

目的总结急性肠系膜上动脉栓塞小肠广泛坏死的治疗经验。方法对 1991～1999年收治的急性肠系膜上动脉栓塞小肠广泛坏死 7例的临床资料进行回顾性分析。结果 7例术后剩留小肠 2 8～ 30cm的 3例 ,70～ 90cm的 4例。本组 2例术后死于感染中毒性休克 ;5例发生短肠或超短肠综合征 ,经静脉营养与经口进食等综合治疗全部治愈。本组随访 18个月 4例、36个月 1例 ,均健在。结论及时诊断和早期手术是提高治愈率的关键。尽可能保留有生机的肠段 ,对术后剩留小肠在 2 8～ 90cm的短肠和超短肠综合征 ,采取静脉营养和经口进食并举的综合治疗 ,可以较快恢复肠管的消化吸收功能。

Objective To summarize our experience in the management of extensive small bowel necrosis from acute superior mesenteric arterial (SMA) embolism. MethodsSeven cases with extensive small bowel necrosis from acute SMA embolism were treated from 1991 to 1999. Results In this group small bowel of 28～ 30 cm and 70～90 cm were remained respectively in 3 and 4 cases after surgery. Two patients died of septic shock while the other 5 developed short or ultra short bowel syndrome and were finally cured by means of combined intravenous nutrition and oral feeding. 5 patients were followed up for 18～36 months, all are in good health. Conclusions Timely diagnosis and prompt operation are important to elevated survival rate. SMA embolectomy helps in preserving living intestine. For patients with short or ultra short bowel syndrome, comprehensive measures of intravenous nutrition and stepwise oral feeding in combination can quickly restore digestive and absorptive function of the residual intestine.