Acosta S, Björck M
Department of Surgery, Blekinge County Hospital-Karlskrona, SE-371 85 Karlskrona, Sweden.
Eur J Vasc Endovasc Surg. 2003 Aug;26(2):179-83. doi: 10.1053/ejvs.2002.1893.
to characterize the clinical presentation of patients with acute thrombo-embolic occlusion of the superior mesenteric artery (SMA).
prospective study.
twenty-four consecutive patients admitted to Blekinge County Hospital, Karlskrona, Sweden, with acute thrombo-embolic occlusion of the SMA, over a three-year period from April 1999 through March 2002.
clinical data were registered prospectively. Incidence, diagnostic procedures and factors associated with survival were analysed.
the diagnosis was verified at operation in 20, and at autopsy in 4 patients. The incidence was 5.3 per 100 000 inhabitants per year. Among the 20 patients with embolic disease, atrial fibrillation was present in 95%, synchronous embolic events in 30% and warfarin treatment in 10%. D-dimer was elevated on admission in 13/13. Four patients were diagnosed at first consultation. Fifteen underwent curative revascularisation (6) or bowel resection only (9). Five were alive at one-year follow-up, of whom one had short bowel syndrome. Length of bowel ischaemia predicted institutional (p = 0.004) and one-year mortality (p = 0.005).
the incidence was higher than expected. Embolic occlusions predominated. Old age, atrial fibrillation, severe abdominal pain and synchronous embolus suggest the diagnosis of acute bowel ischaemia. Length of bowel ischaemia predicted outcome.
描述肠系膜上动脉（SMA）急性血栓栓塞性闭塞患者的临床表现。
前瞻性研究。
1999年4月至2002年3月的三年间，瑞典卡尔斯克鲁纳布莱金厄郡医院收治的24例连续的SMA急性血栓栓塞性闭塞患者。
前瞻性记录临床数据。分析发病率、诊断程序及与生存相关的因素。
20例患者手术时确诊，4例患者尸检时确诊。发病率为每年每10万居民5.3例。在20例栓塞性疾病患者中，95%存在心房颤动，30%有同步栓塞事件，10%接受华法林治疗。13例患者入院时D-二聚体升高。4例患者初诊时确诊。15例患者接受了根治性血管重建术（6例）或仅行肠切除术（9例）。5例患者在一年随访时存活，其中1例患有短肠综合征。肠缺血时间可预测院内死亡率（p = 0.004）和一年死亡率（p = 0.005）。
发病率高于预期。栓塞性闭塞为主。老年、心房颤动、严重腹痛和同步栓子提示急性肠缺血的诊断。肠缺血时间可预测预后。
