Ritz J-P, Buhr H J
Klinik für Allgemein-, Gefäss- und Thoraxchirurgie, Chirurgische Klinik I, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Deutschland.
Chirurg. 2011 Oct;82(10):863-6, 868-70. doi: 10.1007/s00104-011-2098-4.
Acute mesenteric ischemia (AMI) is a rare cause of acute abdomen. Coupled with a high patient age, non-specific clinical symptoms and a significant co-morbidity the disease is still associated with a significant mortality of 60-85%. With a combination of preexisting cardiac arrhythmia and sudden abdominal pain AMI should always first be ruled out. Contrast-enhanced computed tomography (CT) scanning has replaced angiography as the first diagnostic step, largely because both intravascular and intra-abdominal pathologies can be diagnosed. In the case of an acute abdomen or lack of immediate access to diagnostic tools, rapid surgical exploration should be preferred. Surgical therapy includes embolectomy and resection of ischemic bowel segments. There should be a wide indication for second-look surgery. The most important prognostic factor and the only factor that can be influenced by the surgeon is the time interval between onset of symptoms and surgery. Therefore angiography or laparotomy should be performed as early as possible in cases of suspected AMI.
急性肠系膜缺血（AMI）是急性腹痛的罕见病因。由于患者年龄较大、临床症状不具特异性且合并症严重，该病的死亡率仍高达60% - 85%。若患者同时存在心脏心律失常和突发腹痛，应首先排除AMI。对比增强计算机断层扫描（CT）已取代血管造影成为首要诊断步骤，主要是因为其能够诊断血管内和腹腔内的病变。对于急性腹痛或无法立即获得诊断工具的情况，应首选快速手术探查。手术治疗包括栓子切除术和切除缺血肠段。二次探查手术的指征应放宽。最重要的预后因素以及唯一可由外科医生控制的因素是症状出现至手术的时间间隔。因此，在怀疑AMI的情况下应尽早进行血管造影或剖腹手术。
