急性肠系膜上动脉缺血41例诊治体会  

Diagnosis and Treatment Experience:Acute Superior Mesenteric Artery Ischemia 41 Cases

作　　者：王雪钢[1] 白斗[1] 武少辉 张效杰[1] 高林 蒋岚杉[1] Wang Xuegang;Bai Dou;Wu Shaohui(Department of Vascular Surgery,Mianyang Central Hospital,Mianyang,Sichuan 621000,China)

机构地区：[1]绵阳市中心医院血管外科,四川绵阳621000

出　　处：《四川医学》2020年第10期1036-1039,共4页Sichuan Medical Journal

摘　　要：目的探讨对因肠系膜上动脉(SMA)病变引起的急性肠缺血患者的诊断和治疗方法的选择及死亡原因分析。方法对2016年1月至2018年12月我院收治的41例急性肠缺血患者的临床资料进行回顾性分析。其中肠系膜上动脉栓塞21例,中心型7例,周围型10例,混合型4例;孤立性肠系膜上动脉夹层8例;肠系膜上动脉血栓12例。结果肠系膜上动脉栓塞中剖腹探查+取栓4例(肠切除后短肠综合征1例),介入置管溶栓手术4例(1例死亡),置入支架治疗4例(1例术后1周脑梗);药物保守治疗27例(5例死亡),2例放弃治疗死亡。结论SMA局限性夹层主张保守治疗,若疼痛持续不缓解或加重则选择腔内治疗;SMA主干栓塞主张切开取栓,病程较长且有腹膜炎者主张剖腹探查+肠切除;混合及周围型栓塞视情况则可以腔内或药物治疗。Objective To explore diagnosis and treatment of acute intestinal ischemia patients caused by superior mesenteric artery(SMA)lesions and analyze death reason.Method From January 2016 to December 2018,clinical data of 41 patients with acute intestinal ischemia were retrospectively analyzed.Among them,superior mesenteric artery embolism had 21 cases,central type had 7 cases,peripheral type had 10 cases,mixed type had 4 cases,solitary superior mesenteric artery dissection had 8 cases,superior mesenteric artery thrombosis had 12 cases.Results In superior mesenteric artery embolization,4 cases were laparotomy+thrombectomy(1 case of short bowel syndrome after bowel resection),4 cases were interventional catheterization thrombolysis(1 case died),4 cases were stent placement(1 case had peripheral cerebral infarction after operation),27 cases were treated conservatively with drugs(4 cases died),and 2 cases died after giving up treatment.Conclusion Conservative treatment is used for SMA limited dissection.If pain persists without relieve or worsens,intracavitary treatment should be chosen.Incision and embolization are used for SMA main trunk embolization.Laparotomy+bowel resection was used for patients with longer disease course and peritonitis.Mixed and peripheral embolism could be treated intracavitary or medication appropriately.

关 键 词：急性肠缺血 肠系膜上动脉 栓塞 动脉夹层 

分 类 号：R657.2[医药卫生—外科学]