Yamazaki Fumio, Shimamoto M, Nakai M, Fujita S, Masumoto H, Itonaga T, Nomura R
Department of Cardiovascular Surgery, Shizuoka City Hospital, Shizuoka, Japan.
Kyobu Geka. 2007 Apr;60(4):309-14.
Mesenteric ischemia is a dreaded complication of acute type A aortic dissection. From January 1994 to December 2004, 134 patients with acute type A aortic dissection were operated. Eleven patients showed postoperative mesenteric ischemia. Mortality of such patients was much higher than that without mesenteric ischemia (81.8 vs. 10.6% , p < 0.0001). Preoperative mesenteric and/or lower extremity ischemia were revealed to be the risk factors of postoperative mesenteric ischemia. Our strategy to manage these patients is as follows; patients who are suffering mesenteric and/or lower extremity ischemia preoperatively, or those whose computed tomography (CT) shows stenosis, obstruction, or dissection of the superior mesenteric artery, should be recognized as high-risk patients of postoperative mesenteric ischemia. Their mesenteric circulation should be examined directly with laparotomy after the central repair. If the mesenteric circulation seems to be suboptimal, iliac artery-superior mesenteric artery bypass should be performed.
肠系膜缺血是急性A型主动脉夹层的一种可怕并发症。1994年1月至2004年12月，对134例急性A型主动脉夹层患者进行了手术。11例患者术后出现肠系膜缺血。此类患者的死亡率远高于未发生肠系膜缺血的患者（81.8%对10.6%，p<0.0001）。术前肠系膜和/或下肢缺血被证实是术后肠系膜缺血的危险因素。我们处理这些患者的策略如下：术前患有肠系膜和/或下肢缺血的患者，或计算机断层扫描（CT）显示肠系膜上动脉狭窄、阻塞或夹层的患者，应被视为术后肠系膜缺血的高危患者。在进行中心修复后，应通过剖腹手术直接检查其肠系膜循环。如果肠系膜循环似乎不理想，应进行髂动脉-肠系膜上动脉旁路移植术。
