Seeger J M, Coe D A, Kaelin L D, Flynn T C
Department of Surgery, University of Florida, College of Medicine, Gainesville 32610-0286.
J Vasc Surg. 1992 Apr;15(4):635-41.
Ischemic colitis resulting in colonic infarction after aortic reconstruction is a highly lethal complication. Reimplantation of all patent inferior mesenteric arteries should improve this problem but can be justified only if the procedure is effective and safe. To investigate this, 337 aortic reconstructions done between July 1982 and May 1989 were reviewed. Patent inferior mesenteric arteries had been reimplanted when possible during 151 aortic reconstructions done between April 1986 and May 1989. Before this, patent inferior mesenteric arteries were selectively ligated on the basis of intraoperative bowel inspection, colonic mesenteric Doppler signals, and inferior mesenteric arteries stump pressures during 186 aortic procedures. No patient had colonic infarction as a result of ischemia during the period in which patent inferior mesenteric arteries were reimplanted if possible. In contrast, five patients (2.7%; p less than 0.05) had colonic infarction and perforation during the period of selective inferior mesenteric arteries ligation resulting in four deaths. The operative mortality rate was less during the period of inferior mesenteric arteries reimplantation (4.0% vs 14.5%; p less than 0.05), and transfusion requirements were unchanged. Thus routine reimplantation of patent inferior mesenteric arteries limits colonic infarction and operative deaths after aortic reconstruction.
主动脉重建术后发生的缺血性结肠炎导致结肠梗死是一种致死率很高的并发症。将所有通畅的肠系膜下动脉重新植入应能改善这一问题，但只有该手术有效且安全时才具有合理性。为对此进行研究，回顾了1982年7月至1989年5月期间进行的337例主动脉重建手术。在1986年4月至1989年5月期间进行的151例主动脉重建手术中，尽可能对通畅的肠系膜下动脉进行了重新植入。在此之前，在186例主动脉手术中，根据术中肠管检查、结肠系膜多普勒信号以及肠系膜下动脉残端压力，对通畅的肠系膜下动脉进行了选择性结扎。在尽可能重新植入通畅的肠系膜下动脉的时期内，没有患者因缺血而发生结肠梗死。相比之下，在选择性结扎肠系膜下动脉期间，有5例患者（2.7%；p<0.05）发生了结肠梗死和穿孔，导致4例死亡。在肠系膜下动脉重新植入期间，手术死亡率较低（4.0%对14.5%；p<0.05），输血需求未变。因此，常规重新植入通畅的肠系膜下动脉可限制主动脉重建术后的结肠梗死和手术死亡。
