肠系膜上动脉栓塞的外科诊治:18例报告

Diagnosis and surgical management of acute superior mesenteric artery embolism:a report of 18 cases

目的探讨肠系膜上动脉栓塞的诊断和外科治疗策略及临床疗效。方法回顾性分析2011年1月至2017年6月安徽医科大学第三附属医院18例肠系膜上动脉栓塞病人的临床资料,诊断主要依据病人的病史、腹部症状体征、腹部增强CT或CT血管成像(CTA),少部分病人通过手术探查确诊,治疗方法包括保守治疗和外科手术治疗,外科手术是该病的首选治疗方法,手术方式主要采用肠系膜上动脉切开取栓及坏死小肠切除术。结果保守治疗组4例均死亡,手术治疗组14例有2例死亡,总死亡率33%。结论心脏疾病尤其是房颤、突发剧烈腹痛、胃肠道排空异常是本病早期诊断的主要临床特点,早期诊断、及时手术取栓和切除坏死肠管是有效的治疗手段。

Objective To summarize the experience in the diagnosis and surgical management of acute superior mesenteric artery embolism.Methods A total of 18 patients with acute superior mesenteric artery embolism at the Third Affiliated Hospital of Anhui Medi-cal University from January 2011 to June 2017 were analyzed.The diagnosis was based on the patient’s history,abdominal symptoms and abdominal enhancement CT or CT angiography(CTA),a small number of patients were diagnosed by surgery.Treatment includes conservative treatment and operation,surgery is the preferred treatment for the disease including embolectomy of superior mesenteric artery and necrotic bowel resection.Results All the 4 patients accepted conservative treatment was died.2 of 14 cases accepted surgery were died,the overall mortality was 33%.Conclusions Heart disease,especially atrial fibrillation,sudden abdominal pain and abnormal gastrointestinal emptying are the main clinical features of early diagnosis of this disease.Early diagnosis together with surgical treatments such as embolectomy and necrotic bowel resection are the key points to improve the therapeutic effects.