Falkensammer Juergen, Oldenburg Warner Andrew
Section of Vascular Surgery, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
Curr Treat Options Cardiovasc Med. 2006 Apr;8(2):137-43. doi: 10.1007/s11936-006-0006-x.
Acute mesenteric ischemia frequently results in bowel necrosis, which necessitates laparotomy to assess bowel viability. Reduction in mortality requires a high index of suspicion and prompt diagnosis. Bowel resection should be preceded by visceral artery revascularization. Medical management includes the use of anticoagulation, vasodilators, and the use of inhibitors of reperfusion injury. The management of chronic mesenteric ischemia largely depends on the general condition of the patient, who is often affected by malnutrition and dehydration. Surgery, although associated with greater morbidity and mortality, is more durable and effective in relieving the symptoms of chronic mesenteric ischemia. Endovascular treatment options for chronic mesenteric ischemia include percutaneous balloon angioplasty and stenting. This treatment is more likely to be successful in dealing with stenotic rather than occlusive lesions and offers a minimal invasive approach but is associated with a smaller primary success rate and a higher recurrence rate.
急性肠系膜缺血常导致肠坏死，这就需要进行剖腹手术以评估肠的活力。降低死亡率需要高度的怀疑指数和及时的诊断。在进行肠切除之前应先进行内脏动脉血运重建。药物治疗包括使用抗凝剂、血管扩张剂以及再灌注损伤抑制剂。慢性肠系膜缺血的治疗很大程度上取决于患者的一般状况，患者常受营养不良和脱水影响。手术虽然并发症和死亡率较高，但在缓解慢性肠系膜缺血症状方面更持久有效。慢性肠系膜缺血的血管内治疗选择包括经皮球囊血管成形术和支架置入术。这种治疗在处理狭窄性病变而非闭塞性病变时更有可能成功，提供了一种微创方法，但初始成功率较低且复发率较高。
