急性肠系膜血管缺血性疾病的早期诊断与治疗

Early diagnosis and treatment of acute mesenteric ischemia disease

目的：探讨急性肠系膜血管缺血性疾病的诊断及治疗方法。方法回顾性分析2005年8月至2013年4月阳泉煤业集团第三医院收治的9例急性肠系膜缺血性疾病患者的临床资料。结果9例中肠系膜上动脉栓塞5例，肠系膜静脉血栓形成4例；1例经保守治疗治愈，8例手术患者小肠切除长度50~160 cm，3例术后3~6 d死于感染性休克或多脏器功能衰竭，1例术后出现短肠综合征表现，经全肠外营养治疗后好转。治愈6例，死亡3例，治愈率为33.3%，出院患者随访6~9个月未见复发。结论对急性肠系膜血管缺血性疾病应结合影像学检查动态观察，早期明确诊断，围术期序贯抗凝、溶栓治疗，尽早手术切除坏死肠管，可明显提高治疗效果，降低病死率。

Objective To investigate the diagnosis and treatment of acute mesenteric ischemia disease. Methods The clinical data of 9 patients with acute mesenteric ischemia disease from August 2005 to April 2013 were retrospectively analyzed. Results Among the 9 cases,5 cases of superior mes-enteric arterial embolus and 4 cases of mesenteric venous thrombosis. One patient was cured after treated by conservative treatment,8 patients were treated by operative treatment and the small intestine excision length was 50-160 cm. Three patients died of septic shock or multiple organ failure 3-6 days after the operation,1 patient got the symptoms of short bowel syndrome and got better after treated with total par-enteral nutrition therapy. Six patients were cured and 3 patients were dead,the recovery rate was 33. 3%. There was no recurrence after 6-9 months followed-up. Conclusions For the patients with a-cute mesenteric vessel disease,should combine with dynamic imageological examination,clarify a diagno-sis in the early phase,take sequential anticoagulation and thrombolysis in perioperative period and cut off the necrotic bowel as early as possible to do which can enhance the therapeutic effect and reduce the case fatality rate.