Lock G
Department of Internal Medicine, University of Regensburg, Regensburg, D-93042, Germany.
Best Pract Res Clin Gastroenterol. 2001 Feb;15(1):83-98. doi: 10.1053/bega.2000.0157.
The subsets of acute mesenteric ischaemia include mesenteric arterial occlusion (by embolus or thrombosis), mesenteric venous thrombosis and non-occlusive mesenteric ischaemia. Despite advances in pathophysiology, laboratory diagnosis and imaging techniques, acute mesenteric ischaemia is still associated with mortality rates of more than 60% and continues to be a challenging diagnostic problem. The key to a better outcome (and the main problem in clinical practice) is early diagnosis. Clinical presentation may be unspecific, but is often characterized by an initial discrepancy between severe subjective pain and relatively unspectacular findings on physical examination. Up to now, there are no simple and non-invasive diagnostic tests of sufficient sensitivity and specificity; thus, angiography remains the cornerstone of diagnosis and should be performed early in all patients in which mesenteric ischaemia is a realistic differential diagnosis. Treatment for obstructive mesenteric arterial syndromes and most patients with mesenteric venous thrombosis is surgical, whereas non-occlusive mesenteric ischaemia may be managed by pharmacological vasodilation.
急性肠系膜缺血的亚型包括肠系膜动脉闭塞（由栓子或血栓形成引起）、肠系膜静脉血栓形成和非闭塞性肠系膜缺血。尽管在病理生理学、实验室诊断和成像技术方面取得了进展，但急性肠系膜缺血的死亡率仍超过60%，仍然是一个具有挑战性的诊断难题。取得更好预后的关键（也是临床实践中的主要问题）是早期诊断。临床表现可能不具特异性，但通常的特点是起初严重的主观疼痛与体格检查中相对不明显的发现之间存在差异。到目前为止，尚无足够敏感性和特异性的简单非侵入性诊断检查；因此，血管造影术仍然是诊断的基石，对于所有肠系膜缺血为实际鉴别诊断的患者均应尽早进行。阻塞性肠系膜动脉综合征和大多数肠系膜静脉血栓形成患者的治疗方法是手术治疗，而非闭塞性肠系膜缺血可通过药物性血管舒张进行处理。
