急性肠系膜血管闭塞24例诊治分析

A retrospective study of diagnosis and management in 24 cases of acute mesenteric vascular occlusion

目的 探讨急性肠系膜血管闭塞 (AMVO)的早期诊断及外科治疗方法。方法 回顾性总结 1987年 8月至 2 0 0 2年 8月收治的 2 4例AMVO ,对其临床特征、外科诊断治疗方法及预后进行分析。结果 2 4例AMVO中肠系膜上动脉栓塞 (MAE) 9例 ( 3 7 5 % ) ,肠系膜上静脉血栓形成 (MVT) 13例 ( 5 4 2 % ) ,肠系膜上动脉血栓形成 (MAT) 2例 ( 8 3 % )。最常见的临床表现为腹痛 ( 91 7% )。最可靠的诊断方法为肠系膜血管造影 ( 10 0 % )。 9例MAE确诊 7例。保守治疗 3例 ,急诊手术 6例。治愈 5例 ,死亡 4例。 13例MVT确诊 10例。保守治疗 7例 ,介入治疗 2例 ,手术 4例。全部治愈。 2例MAT均确诊 ,介入与手术治疗各 1例 ,均治愈。结论 肠坏死发生前早期诊断。

Objective To investigate the methods of early diagnosis and management of the acute mesenteric vascular occlusion (AMVO). Methods The clinical data of 24 cases of AMVO From August 1987 to August 2002,were retrospectively reviewed,diagnosis procedure,surgical treatment,and prognosis were analyzed.Results The cause of AMVO was mesenteric artery embolism(MAE) in 9 patients(37 5%),mesenteric venous thrombosis(MVT) in 13 patients(54 2%),and mesenteric artery thrombosis(MAT) in two patients(8 3%).Abdominal pain was the most common symptom (91 7%).The most valuable examination was selective mesenteric arteriography.In 9 cases of MAE,7 cases were definitely diagnosed.Three cases were treated non operatively,6 cases received emergency operation.Five were recovered and 4 died.In 13 cases of MVT,10 cases were definitely diagnosed.Seven cases were treated non operatively,2 cases received catheter directed thrombolysis,4 cases received operation.All of the 13 cases of MVT recovered.Both cases of MAT were definitely diagnosed and recovered after interventional and surgical treatment in each one.Conclusion Early diagnosis before intestinal infarction and aggressive treatment mainly including interventional and surgical treatment are the key to better prognosis in AMVO.