急性肠系膜上动脉栓塞的外科治疗

Surgical Treatment of Acute Superior Mesenteric Artery Embolism

急性肠系膜上动脉栓塞(acute superior mesenteric artery embolism,ASMAE)是急性肠系膜缺血的一种常见类型,约占急性肠系膜缺血的70%。急性肠系膜上动脉栓塞发病急骤,进展迅速,在病程早期,症状与体征不符,极易漏诊和误诊,导致治疗不及时,死亡率极高。目前CT血管造影已经取代传统的介入血管造影成为ASMAE首选的检查手段。ASMAE的治疗原则是早期消除阻塞原因,恢复肠管血流灌注。腔内治疗是当前ASMAE首选治疗方式,但开放手术在评估肠管活性方面也有其独特优势。对于有腹膜炎征象或怀疑肠坏死者,及时外科手术十分必要。

Acute superior mesenteric artery embolism(ASMAE)is a common type of acute mesenteric ischemia,accounting for about 70%of acute mesenteric ischemia.ASMAE is an acute disease with rapid progression.In the early stage of the disease,the symptoms and signs are not consistent,and it is easy to be missed and misdiagnosed,resulting in delayed treatment and extremely high mortality.At present,computed tomography angiography has replaced the conventional angiography as the first choice for diagnosis.The therapeutic principle of ASMAE is to remove the obstructive factors at the early stage and restore the intestinal perfusion.Endovascular therapy is currently the preferred treatment,but open surgery also has unique advantages in evaluating intestinal viability.For patients with peritonitis or suspected intestinal necrosis,timely surgery is necessary.