急性肠系膜上动脉栓塞肠坏死不同手术方式的预后分析  

Effect of surgical methods on the prognosis of patients of acute superior mesenteric artery embolization with intestinal necrosis

作　　者：李云龙 王勉 苗妍 张慧敏 解凤妮 洪流 Li Yunlong;Wang Mian;Miao Yan;Zhang Huimin;Xie Fengni;Hong Liu(Department of Digestive Surgery,Xijing Hospital,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学附属西京医院消化外科,西安710032

出　　处：《中华普通外科杂志》2022年第5期321-324,共4页Chinese Journal of General Surgery

基　　金：陕西省社发公关基金(2020SF-229)。

摘　　要：目的:总结治疗急性肠系膜上动脉栓塞肠坏死的临床经验,探讨影响其预后的危险因素。方法:回顾性分析2008年1月至2020年12月空军军医大学附属西京医院收治的急性肠系膜上动脉栓塞肠坏死患者的临床资料、手术方式、并发症及术后短期随访结果。结果:46例患者30 d总病死率为19.6%,其中肠切除肠造瘘组30 d病死率为12.1%,一期肠吻合组30 d病死率为38.5%。单因素分析显示反跳痛阳性(P=0.025)、平均动脉压(MAP)>105 mmHg(P=0.04)、心率<120次/min(P=0.04)以及Fullen肠管缺血分级(P=0.03)影响急性肠系膜上动脉栓塞肠坏死预后。结论:反跳痛、MAP、心率、Fullen分级以及手术方式显著影响患者预后。肠切除肠造瘘术预后优于肠切除吻合术。Objective To summarize the clinical experience in treating acute superior mesenteric artery embolization with intestinal necrosis.Methods Clinical data,surgical methods,complications and 30-day follow-up of patients with acute superior mesenteric artery embolization and intestinal necrosis admitted at Xijing Hospital of Air Force Military Medical University from Jan 2008 to Dec 2020 were retrospectively analyzed.Results A total of 46 patients were included.The 30-day overall mortality rate was 19.6%,and that of those treated by enterostomy after enterectomy was 12.1%,and that was 38.5%in those undergoing primary entero-anastomosis after enterectomy.Univariate analysis showed that rebound pain was positive(P=0.025),MAP was higher than 105mmHg(P=0.04),heart rate was less than 120 beats/min(P=0.04),and Fullen intestinal ischemia grade(P=0.03)was significantly related to survival rates.Conclusions Rebound pain,MAP,heart rate,Fullen grade,and surgical methods significantly affect the prognosis of patients.More patients survive with intestinal resection and enterostomy than those with intestinal resection and immediate anastomosis.

关 键 词：栓塞 肠系膜上动脉 并发症 预后 

分 类 号：R657.2[医药卫生—外科学]