急性肠系膜上动脉栓塞的诊断和治疗

DIAGNOSIS AND TREATMENT OF ACUTE SUPERIOR MESENTERIC ARTERY EMBOLIZATION

急性肠系膜上动脉栓塞是一种临床少见、病情极危重的急腹症。临床医生常因对本病认识不足而延误治疗 ,是该病治愈率低的主要原因之一。本文回顾性分析了 2 5例急性肠系膜上动脉栓塞的诊断和治疗方法 ,指出对有心脏及动脉硬化病史 ,突发剧烈腹痛 ,持续加重 ,一般止痛剂无效 ,同时伴有胃肠道出血 ,应视为急性肠系膜上动脉闭塞的早期征兆。在 2 3例的手术治疗中 ,肠系膜上动脉取栓及部分小肠切除 5例 ,坏死肠襻切除 18例 ;10例痊愈 ,围手术期死亡 13例 ,死亡率 5 7%。肠系膜上动脉栓塞虽然危重 ,但并非不能治疗 ,只要对本病有足够的警惕和认识 。

Acute superior mesenteric artery embolism(MAE) is uncommon in clinical, but is a severe surgical abdomen. Owing to its unfamiliarity, clinicians often made misdiagnosis. This report summarized the experience in diagnosis and surgical therapy of 25 cases of acute superior mesenteric artery embolism. The results suggested that patients with a history of heart and peripheral arterial obstructive disease encountering severe abdominal pain and hemorrhage of digestive tract, which could not be relieved by narcotics, should be considered as early signs of acute superior mesenteric artery embolism. Twenty-three were operated out of the 25 cases, among tham, 5 cases were subjected to resection of partial small intestine after removal of the embolus, 18 cases received bowel resection. In the 23 cases of MAE, 10 were cured and 13 died, the mortality in perioperative period was 57%. Early diagnosis and prompt treatment are the key to improve the therapeutic effects of AME.