Safioleas M C, Moulakakis K G, Papavassiliou V G, Kontzoglou K, Kostakis A
2 Department of Propaedeutic Surgery, Athens University Medical School, Laiko Hospital, Greece.
Vasa. 2006 May;35(2):106-11. doi: 10.1024/0301-1526.35.2.106.
Acute mesenteric ischaemia remains a serious condition requiring emergency, surgical management. The mortality rate still remains high, due to the unspecific and delayed diagnosis and ranges from 59% to 100%. Purpose of our study is to present our experience in the management of the disease.
This is a retrospective study of 61 patients treated surgically for acute mesenteric ischaemia, between 1988 and 2004. All patients underwent a laparotomy. 75% of the patients were operated within the first 24 hours and the rest within 48 hours.
Superior mesenteric artery embolism occurred in 36 (59%), thrombosis in 21 (34%) and superior mesenteric vein thrombosis in 4 (7%) cases. In 49 (80%) cases, embolectomy or thrombectomy of the superior mesenteric artery with resection of the necrotic segment of the bowel was performed. Twelve cases (20%) were considered inoperable because of massive bowel necrosis. According to our study mortality and morbidity rate amounts to 75% and 80% respectively. No significant difference in the mortality rate between patients with embolism (75%) and thrombosis (76%) was found. However a significant increase of mortality rate was observed when the surgical intervention became afterwards the first 24-hour period. (72% versus 87%). Patients who underwent embolectomy or thrombectomy with bowel resection presented an improved survival rate compared with patients that underwent only bowel resection. (p = 0.019)
Acute mesenteric ischaemia has the characteristics of a highly lethal condition and only early recognition and appropriate treatment can reduce the potential for a devastating outcome. The reduction of time interval from the beginning of symptoms up to the treatment remains the main critical important factor.
急性肠系膜缺血仍然是一种需要紧急手术治疗的严重疾病。由于诊断不特异且延迟，死亡率仍然很高，在59%至100%之间。我们研究的目的是介绍我们在该疾病治疗方面的经验。
这是一项对1988年至2004年间接受急性肠系膜缺血手术治疗的61例患者的回顾性研究。所有患者均接受了剖腹手术。75%的患者在最初24小时内接受手术，其余患者在48小时内接受手术。
肠系膜上动脉栓塞36例（59%），血栓形成21例（34%），肠系膜上静脉血栓形成4例（7%）。49例（80%）患者进行了肠系膜上动脉栓子切除术或血栓切除术，并切除肠坏死段。12例（20%）因广泛肠坏死被认为无法手术。根据我们的研究，死亡率和发病率分别为75%和80%。栓塞患者（75%）和血栓形成患者（76%）的死亡率无显著差异。然而，当手术干预在最初24小时之后进行时，死亡率显著增加（72%对87%）。与仅接受肠切除术的患者相比，接受栓子切除术或血栓切除术并肠切除的患者生存率有所提高（p = 0.019）。
急性肠系膜缺血具有高致死性疾病的特征，只有早期识别和适当治疗才能降低灾难性后果的可能性。从症状开始到治疗的时间间隔缩短仍然是主要的关键重要因素。
