急性肠系膜上动脉缺血性疾病71例诊治分析

Analysis of diagnosis and therapeutic for acute superior mesenteric artery ischemia: a report of 71 cases

目的总结急性肠系膜上动脉缺血性疾病(ASMAI)的诊治经验和临床疗效。方法回顾性分析海南省人民医院血管外科2014年1月至2018年6月收治的71例ASMAI患者(动脉栓塞组34例,血栓形成组21例,动脉夹层组16例)的临床资料,总结其病例特点、治疗方法和效果。结果技术成功率100%。腔内治疗36例(50.7%),其中置管溶栓19例,球囊扩张+支架植入成形17例;开放手术20例(28.2%),其中动脉切开取栓7例,血管重建3例,肠切除吻合10例;保守治疗15例(21.1%)。腔内治疗、开放手术和保守治疗有效率分别为86.1%、85.0%、86.7%,总有效率为85.9%,各种治疗方式有效率差异无统计学意义(χ^2=0.022,P=0.989)。死亡5例,短肠综合症1例,吻合口漏1例。患者平均随访31个月,血栓复发3例,支架内再狭窄(>50%)6例。结论应进一步提高临床医生对ASMAI的认识,掌握其临床特点,综合应用影像手段及时明确诊断,通过综合分析、评估及严密观察,选择合适的个体化治疗方案。

Objective To summarize the experience of diagnosis and treatment of acute superior mesenteric artery ischemic disease (ASMAI) and its clinical efficacy. Methods The clinical data of 71 ASMAI patients (34 in arterial embolism group, 21 in thrombosis group, 16 in arterial dissection group) in Department of Vascular Surgery, Hainan General Hospital from January 2014 to June 2018 were analyzed retrospectively. Results The technical success rate was 100%. Among them, 36 cases (50.7%) received endovascular treatment, with 19 cases received catheter directed thrombolysis and 17 cases received balloon dilatation and stent implantation. 20 cases (28.2%) received open surgery with 7 cases underwent arteriotomy, 3 cases underwent vascular reconstruction and 10 cases underwent intestinal resection and anastomosis;and 15 cases underwent conservative treatment (21.1%). The effective rate was 86.1%, 85.0% and 86.7%, respectively, and the total effective rate was 85.9%. There was no significant difference in the effective rate of all kinds of treatment methods (χ^2=0.022, P=0.989). There were 5 deaths, 1 short bowel syndrome and 1 anastomotic leakage. The average follow-up period was 31 months, 3 cases had thrombosis recurrence, and 6 cases had in-stent restenosis (>50%). Conclusion Clinical doctors should improve their understanding of ASMAI and its clinical characteristics. It is important to make a definite diagnosis in time by appropriate imaging methods, to perform individual treatment through comprehensive analysis, evaluation and close observation.