Yukaya Takafumi, Saeki Hiroshi, Taketani Kenji, Ando Koji, Ida Satoshi, Kimura Yasue, Oki Eiji, Yasuda Mitsuhiro, Morita Masaru, Shirabe Ken, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, 812-8582, Fukuoka, Japan,
J Gastrointest Surg. 2014 Sep;18(9):1642-7. doi: 10.1007/s11605-014-2579-0. Epub 2014 Jul 3.
To date, no large-scale study has been undertaken to understand the clinical features of non-occlusive mesenteric ischemia (NOMI) after surgery. We thus performed a multicenter investigation to clarify the clinical outcomes and prognostic factors of NOMI.
Clinical databases from 22 Japanese facilities were reviewed for evaluation of patients who received surgery for NOMI between 2004 and 2012. NOMI patients (n = 51) were divided into two groups: group I (n = 28) consisted of patients who survived, and group II (n = 23) consisted of patients who did not survived. Prognostic factors were compared between the two groups.
NOMI surgery represented 0.04% of the total number of operations performed in this time period. The overall mortality rate for NOMI surgery was 45%. Hemodialysis was a significant negative prognostic factor (p = 0.027). Preoperative elevation of transaminases, potassium, and white blood cell count, as well as metabolic acidosis and colon ischemia was poor prognostic factors. The mean Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) score of group I versus group II was 54.5 ± 3.6 and 85.2 ± 4.1, respectively (p < 0.001).
Currently, NOMI surgery has a 45% mortality rate. POSSUM scores can be used to predict the clinical outcome of patients who receive NOMI surgery.
迄今为止，尚未开展大规模研究以了解术后非闭塞性肠系膜缺血（NOMI）的临床特征。因此，我们进行了一项多中心调查，以阐明NOMI的临床结局和预后因素。
回顾了来自22家日本医疗机构的临床数据库，以评估2004年至2012年间接受NOMI手术的患者。NOMI患者（n = 51）分为两组：第一组（n = 28）为存活患者，第二组（n = 23）为未存活患者。比较两组之间的预后因素。
NOMI手术占该时间段内手术总数的0.04%。NOMI手术的总体死亡率为45%。血液透析是一个显著的不良预后因素（p = 0.027）。术前转氨酶、钾和白细胞计数升高，以及代谢性酸中毒和结肠缺血都是不良预后因素。第一组与第二组的平均生理和手术严重程度评分系统（POSSUM）评分分别为54.5±3.6和85.2±4.1（p < 0.001）。
目前，NOMI手术的死亡率为45%。POSSUM评分可用于预测接受NOMI手术患者的临床结局。
