Luther Bernd, Mamopoulos Apostolos, Lehmann Christian, Klar Ernst
Department of Vascular Surgery, Maria Hilf Alexianer Hospital, Krefeld, Germany.
Department of Vascular Surgery, Helios Hospital, Krefeld, Germany.
Visc Med. 2018 Jul;34(3):217-223. doi: 10.1159/000490318. Epub 2018 Jun 18.
The lethality of acute mesenteric ischemia (AMI) remains quite high with 50-70%. The main reasons for that are the fact that AMI is rarely taken into consideration by the differential diagnosis of acute abdomen, the time-consuming diagnostic process, and the lack of a standardized therapeutic concept. The present interdisciplinary review aims to increase awareness among physicians and to help improve clinical outcomes.
This clinical therapeutic review is based on author expertise as well as a selective literature survey in PubMed based on the term 'mesenteric ischemia', combined with the terms 'arterial', 'clinical presentation', 'diagnosis', 'therapy', 'surgery', and 'interventional radiology'. Based on these search results as well as on the guidelines of the German Society of Vascular Surgery, the American College of Cardiology, and the American Heart Association, we present an interdisciplinary treatment concept.
AMI is a vascular emergency that can be successfully treated only within the first hours after the onset of symptoms. Computed tomography angiography is the diagnostic method of choice. Intensive care unit treatment can prevent the occurrence of multiple organ failure. Treatment primarily consists of the revascularization of the mesenteric arteries. Endovascular techniques should be given priority, whereas signs of peritonitis or a central arterial occlusion with high thrombus load primarily require a surgical approach in order to save time and increase patient safety. Additional bowel resections can play a significant role in the treatment of intestinal sepsis.
Prompt and goal-oriented diagnosis and consistent treatment of AMI within 4-6 h from the onset of symptoms can be decisive for the reduction of AMI-associated lethality. In order for this to happen, a standardized concept of emergency treatment needs to be implemented.
急性肠系膜缺血（AMI）的致死率仍然很高，为50%-70%。主要原因在于急性腹痛的鉴别诊断中很少考虑到AMI，诊断过程耗时，且缺乏标准化的治疗理念。本次跨学科综述旨在提高医生的认识并帮助改善临床结果。
本临床治疗综述基于作者的专业知识以及在PubMed上以“肠系膜缺血”为关键词，并结合“动脉”“临床表现”“诊断”“治疗”“手术”和“介入放射学”等关键词进行的选择性文献检索。基于这些检索结果以及德国血管外科学会、美国心脏病学会和美国心脏协会的指南，我们提出一种跨学科治疗理念。
AMI是一种血管急症，只有在症状出现后的最初数小时内才能成功治疗。计算机断层扫描血管造影是首选的诊断方法。重症监护病房治疗可预防多器官功能衰竭的发生。治疗主要包括肠系膜动脉血运重建。应优先采用血管内技术，而腹膜炎体征或高血栓负荷的中央动脉闭塞主要需要手术治疗，以便节省时间并提高患者安全性。额外的肠切除术在治疗肠道脓毒症中可发挥重要作用。
从症状出现起4-6小时内对AMI进行及时且目标明确的诊断和持续治疗对于降低AMI相关致死率可能具有决定性意义。为实现这一点，需要实施标准化的急诊治疗理念。
