General and Emergency Surgery-Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffrè, 5, Palermo, Italy.
General and Emergency Surgery-Villa Sofia Hospita, Palermo, Italy.
World J Emerg Surg. 2017 Jan 18;12:4. doi: 10.1186/s13017-017-0118-5. eCollection 2017.
Acute mesenteric ischemia is a rare affection with high related mortality. NOMI presents the most important diagnostic problems and is related with the higher risk of white laparotomy. This study wants to give a contribution for the validation of laparoscopic approach in case of NOMI.
Thirty-two consecutive patients were admitted in last 10 years in ICU of Paolo Giaccone University Hospital of Palermo for AMI. Diagnosis was obtained by multislice CT and selective angiography was done if clinical conditions were permissive. If necrosis was already present or suspected, surgical approach was done. Endovascular or surgical embolectomy was performed when necessary. Twenty NOMI patients underwent medical treatment performing laparoscopy 24 h later to verify the evolution of AMI. A three-port technique was used. In all patients we performed a bed side procedure 48-72 h later in both non-resected and resected group.
In 14 up 20 case of NOMI the disease was extended throughout the splanchnic district, in 6 patients it involved the ileum and the colon; after a first look, only 6 patients underwent resection. One patient died 35 h after diagnosis of NOMI. The second look, 48 h later, demonstrated 4 infarction recurrences in the group of resected patients and onset signs of necrosis in 5 patients of non-resected group. A total of 15 resections were performed on 11 patients. Mortality rate was 6/20-30% but it was much higher in resected group (5/11-45,5%). Non-therapeutic laparotomy was avoided in 9/20 patients and in this group mortality rate was 1/9-11%. No morbidity was recorded related to laparoscopic procedure.
Laparoscopy could be a feasible and safety surgical approach for management of patient with NOMI. Our retrospective study demonstrates that laparoscopy don't increase morbidity, reduce mortality avoiding non-therapeutic laparotomy.
急性肠系膜缺血是一种罕见的疾病，死亡率很高。非手术治疗的肠系膜缺血（NOMI）存在最重要的诊断问题，并且与更高的剖腹手术风险相关。本研究旨在为 NOMI 腹腔镜治疗提供验证。
在过去的 10 年中，32 例连续患者因 AMI 入住巴勒莫 Paolo Giaccone 大学医院的 ICU。通过多层 CT 诊断，并在临床情况允许的情况下进行选择性血管造影。如果已经存在或怀疑有坏死，进行手术治疗。必要时进行血管内或手术取栓。20 例 NOMI 患者接受内科治疗，在 24 小时后进行腹腔镜检查以验证 AMI 的演变。使用三孔技术。在所有患者中，我们在非切除组和切除组均在床边进行 48-72 小时后的后续操作。
在 20 例 NOMI 中，有 14 例疾病扩展到整个内脏区，6 例累及回肠和结肠；初次检查后，仅 6 例进行了切除。1 例患者在诊断为 NOMI 后 35 小时死亡。48 小时后的第二次检查显示，在切除组中，4 例发生再梗死，5 例非切除组出现坏死迹象。11 例患者共进行了 15 次切除。死亡率为 20-30%（6/20），但在切除组中更高（5/11-45.5%）。在 20 例患者中有 9 例避免了非治疗性剖腹手术，在该组中死亡率为 1/9-11%。没有与腹腔镜手术相关的发病率记录。
腹腔镜检查对于 NOMI 患者的管理是一种可行且安全的手术方法。我们的回顾性研究表明，腹腔镜手术不会增加发病率，降低死亡率，避免非治疗性剖腹手术。
