Gong Jian-Feng, Zhu Wei-Ming, Wu Xing-Jiang, Li Ning, Li Jie-Shou
Department of General Surgery, Jinling Hospital, Nanjing 200000, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2010 Jan;13(1):22-5.
To examine the outcome of damage control surgery (DCS) in patients with acute mesenteric ischemia (AMI).
Clinical data of 15 consecutive AMI cases treated with DCS from May 2001 to March 2009 at the Research Institute of General Surgery, Jinling Hospital were retrospectively analyzed. Eleven patients had acute superior mesenteric vein thrombosis (MVT) on admission, and 4 suffered from acute mesenteric arterial embolism/thrombosis (MAE/MAT). The staged damage control approach included immediate resection of the involved bowel (but no attempts to restore gastrointestinal continuity), open thrombectomy, transfer of the patients to ICU for resuscitation, and thrombolysis prior to the planned definitive reconstructive procedure.
Of 15 patients, 10 (66.7%) survived. The mean remnant small bowel length was (209.0+/-53.8) cm (120 to 280 cm). None of the survived patients was parenteral nutrition-dependent. Of the 5 deaths, 2 died of recurrence of thrombosis and necrosis of the remaining bowel,1 of massive gastrointestinal bleeding. One patient abandoned treatment intra-operatively, and another with total small bowel resection abandoned treatment postoperatively.
Damage control approach improves the survival of patients with AMI. Thrombectomy and thrombolysis are necessary for AMI management to prevent progression or further development of the thrombosis.
探讨损伤控制手术（DCS）治疗急性肠系膜缺血（AMI）患者的疗效。
回顾性分析2001年5月至2009年3月在金陵医院普通外科研究所接受DCS治疗的15例连续AMI患者的临床资料。11例患者入院时诊断为急性肠系膜上静脉血栓形成（MVT），4例为急性肠系膜动脉栓塞/血栓形成（MAE/MAT）。分期损伤控制方法包括立即切除受累肠段（但不尝试恢复胃肠道连续性）、开放血栓切除术、将患者转入重症监护病房（ICU）进行复苏，以及在计划的确定性重建手术前进行溶栓治疗。
15例患者中，10例（66.7%）存活。残余小肠平均长度为（209.0±53.8）cm（120至280cm）。所有存活患者均不依赖肠外营养。5例死亡患者中，2例死于血栓复发和剩余肠段坏死，1例死于大量胃肠道出血。1例患者术中放弃治疗，另1例全小肠切除术后放弃治疗。
损伤控制方法可提高AMI患者的生存率。血栓切除术和溶栓治疗对于AMI的治疗是必要的，以防止血栓进展或进一步发展。
