Acosta S, Nilsson T K, Björck M
Department of Surgery, Blekinge Hospital Karlskrona, Karlskrona, Sweden.
Br J Surg. 2001 Mar;88(3):385-8. doi: 10.1046/j.1365-2168.2001.01711.x.
Occlusion of the superior mesenteric artery (SMA) demands prompt recognition and diagnosis. No accurate diagnostic method is available. The aim of this study was to determine whether the fibrinolytic marker D-dimer is a useful early marker of acute bowel ischaemia.
Fourteen patients suspected of having acute bowel ischaemia were analysed for an increase in plasma D-dimer level.
Six patients had embolic or thrombotic occlusion of the SMA and all had significantly higher D-dimer levels than those without thromboembolic occlusion (P < 0.05). Four patients with strangulation of the small bowel due to adhesions and one with a ruptured aortic aneurysm also had raised D-dimer values.
In patients with suspected thromboembolic occlusive disease of the SMA, a raised level of D-dimer indicated the presence of acute bowel ischaemia, whatever the cause. A more extensive prospective study is needed to evaluate a potential survival benefit using the test as a marker of the need for urgent laparotomy.
肠系膜上动脉（SMA）闭塞需要迅速识别和诊断。目前尚无准确的诊断方法。本研究的目的是确定纤溶标志物D - 二聚体是否为急性肠缺血的有用早期标志物。
对14例疑似急性肠缺血患者分析其血浆D - 二聚体水平的升高情况。
6例患者发生SMA栓塞或血栓形成性闭塞，所有患者的D - 二聚体水平均显著高于无血栓栓塞性闭塞的患者（P < 0.05）。4例因粘连导致小肠绞窄的患者和1例主动脉瘤破裂患者的D - 二聚体值也升高。
在疑似SMA血栓栓塞性闭塞疾病的患者中，无论病因如何，D - 二聚体水平升高提示存在急性肠缺血。需要进行更广泛的前瞻性研究，以评估将该检测作为紧急剖腹手术必要性标志物时潜在的生存获益。
