Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
J Surg Res. 2019 Jan;233:231-239. doi: 10.1016/j.jss.2018.08.010. Epub 2018 Aug 31.
Early identification of patients with acute mesenteric ischemia (AMI) involving the large bowel may play a decisive role in improving the prognosis of AMI. This study aims to compare the outcomes between patients with isolated AMI and AMI patients with colon involvement (CI) and to identify the predictors of worse outcomes. The different surgical modalities for AMI patients with CI were also evaluated.
This retrospective cohort study included 199 AMI patients admitted from January 2005 to January 2014. Based on colonoscopy and pathology reports, 39 patients were diagnosed as AMI with CI, and 160 were AMI patients without CI. The clinical outcomes and different surgical modalities were compared. Risk factors of 30-d mortality and short bowel syndrome (SBS) were identified.
The 30-d mortality (10% versus 49%, P < 0.01) and SBS incidence (19% versus 49%, P < 0.01) were higher in AMI patients with CI than AMI patients without CI. AMI patients with CI have higher rate of bowel resection (68% versus 95%, P < 0.001) and second-look laparotomy (25% versus 54%, P < 0.001) than patients with AMI alone. For AMI patients with CI, emergent laparotomy was associated with shorter hospital stay (P = 0.04) and less incidence of SBS (74% versus 25%, P < 0.001) than initial endovascular therapy. Patients with ostomy had less repeated bowel resection (11% versus 63%, P = 0.001) and rate of SBS (21% versus 79%, P < 0.001) than patients with primary bowel anastomosis. Serum procalcitonin level and colon ischemia were risk factors of 30-d mortality and SBS for AMI.
AMI patients with CI represent a special cohort of AMI patients with higher risk of poor outcome. Compared to initial endovascular therapy, emergent laparotomy was associated with shorter length of hospital stay and reduced incidence of SBS.
早期识别累及大肠的急性肠系膜缺血（AMI）患者可能对改善 AMI 预后起决定性作用。本研究旨在比较单纯 AMI 患者与 AMI 合并结肠受累（CI）患者的结局，并确定预后不良的预测因素。还评估了 AMI 合并 CI 患者的不同手术方式。
本回顾性队列研究纳入了 2005 年 1 月至 2014 年 1 月期间收治的 199 例 AMI 患者。根据结肠镜和病理报告，39 例患者被诊断为 AMI 合并 CI，160 例患者为 AMI 不合并 CI。比较了临床结局和不同的手术方式。确定了 30 天死亡率和短肠综合征（SBS）的危险因素。
AMI 合并 CI 患者的 30 天死亡率（10%比 49%，P<0.01）和 SBS 发生率（19%比 49%，P<0.01）均高于单纯 AMI 患者。AMI 合并 CI 患者的肠切除术率（68%比 95%，P<0.001）和二次剖腹探查术率（25%比 54%，P<0.001）均高于单纯 AMI 患者。对于 AMI 合并 CI 患者，紧急剖腹手术与较短的住院时间（P=0.04）和较低的 SBS 发生率（74%比 25%，P<0.001）相关，而初始血管内治疗则不然。有造口的患者再次肠切除术的次数更少（11%比 63%，P=0.001），SBS 发生率也更低（21%比 79%，P<0.001），而初次肠吻合的患者则不然。血清降钙素原水平和结肠缺血是 AMI 患者 30 天死亡率和 SBS 的危险因素。
AMI 合并 CI 的患者是 AMI 患者中具有较高不良预后风险的一个特殊群体。与初始血管内治疗相比，紧急剖腹手术与较短的住院时间和降低的 SBS 发生率相关。
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