急性肠系膜缺血性疾病早期诊断及手术时机的探讨
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刘建夏

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Early diagnosis and operation timing of acute mesenteric ischemia
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    摘要:

    目的: 探讨急性肠系膜缺血性疾病(AMI)的早期诊断及手术时机。
    方法:对收治的21例AMI患者的临床特征、外科诊断治疗方法及预后进行回顾性分析。
    结果: 21例中行彩色多普勒超声检查确诊5例, 螺旋CT检查确诊11例, 血管造影确诊2例, 术中确诊3例。经全身溶栓抗凝保守治疗痊愈1例, 经导管溶栓抗凝治疗痊愈1例, 经术中Fogarty导管取栓溶栓后完全恢复3例, 经导管取栓溶栓后行小肠部分切除8例, 行“secondlook”手术2例, 再次手术时均行部分肠切除;行小肠大部分切除6例。术后发生短肠综合征3例, 死亡3例。
    结论:影像学检查是诊断AMI的主要方法, 根据病情变化选用适当的治疗方法、对有手术指征者严格把握手术时机是获得早期诊断和良好治疗效果的关键。

    Abstract:

    Objective:To study the diagnosis and operation timing of acute mesenteric ischemia (AMI).
    :Methods :A retrospective analysis based on the clinical characteristics, the methods of diagnosis and treatment, and operative results of 21 patients with AMI admitted in our hospital from January 1997 to December 2007 was performed.
    :Results:The diagnosis were certified by color doppler ultrasonography in five cases, spiral CT in eleven cases, DSA in two cases, and abdominal exploration in three cases. One case was cured by anticoagulation / thrombolytic therapy; and one case was confirmed with selective vascular angiography and cured by urokinase perfusion via the catheter; after removing the thrombus followed by anticoagulation / thrombolytic via Fogarty balloon catheter, ischemia of intestine completely recovered in three cases, partial small bowel resection were performed in eight cases, “secondlook” operation in two cases, and subtotal small bowel resection in six cases. Three cases developed shortgut syndrome and three cases died after operation.
    :Conclusions:Imageological examination is essential for diagnosis of doubtful cases of AMI, and adequate treatments and timely selection of operation are critical to attain early diagnosis and good results.

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郝清斌, 刘建夏, 钱海鑫.急性肠系膜缺血性疾病早期诊断及手术时机的探讨[J].中国普通外科杂志,2008,17(12):13-120.
DOI:10.7659/j. issn.1005-6947.2008.12.013

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  • 在线发布日期: 2008-12-25