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急性肠系膜缺血二期手术的适应证和操作步骤。

Indications and procedures for second-look surgery in acute mesenteric ischemia.

机构信息

Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Harbin, 150001, Heilongjiang Province, PR China.

出版信息

Surg Today. 2010 Aug;40(8):700-5. doi: 10.1007/s00595-009-4140-4. Epub 2010 Jul 30.

Abstract

Acute mesenteric ischemia (AMI) is a highly lethal clinical entity associated with high morbidity and mortality. Bowel necrosis often results, usually necessitating bowel resection; however, deciding on the extent of resection is problematic as accurate identification of ischemic bowel that may undergo subsequent infarction is difficult. Therefore, a second-look laparotomy after the first operation is usually recommended. While the second-look procedure is widely accepted, its optimal indications and mode are still controversial, raising questions such as "second-look or not?," "planned relaparotomy or relaparotomy on demand?," and "open or laparoscopic?" In this review we discuss the relevant literature and reassess the role of the second-look operation in the treatment of AMI.

摘要

急性肠系膜缺血(AMI)是一种高致死率的临床病症,其发病率和死亡率均较高。通常会导致肠坏死,往往需要进行肠切除术;然而,由于准确识别可能发生后续梗死的缺血肠较为困难,因此决定切除范围存在问题。因此,通常建议在第一次手术后进行二次剖腹手术。虽然二次探查术已被广泛接受,但它的最佳适应证和模式仍存在争议,引发了一些问题,如“是否进行二次探查?”“计划性再次剖腹手术还是按需再次剖腹手术?”以及“开放性手术还是腹腔镜手术?”在本文中,我们讨论了相关文献,并重新评估了二次探查手术在 AMI 治疗中的作用。

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