Department of Radiology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinstrasse 51, 20251, Hamburg, Germany.
Surg Endosc. 2020 Dec;34(12):5327-5330. doi: 10.1007/s00464-019-07321-9. Epub 2019 Dec 12.
Non-occlusive mesenteric ischemia (NOMI) is a mesenteric ischemic disease with considerably high mortality rate, although little has been known about what factors affect the patients' prognosis. The purpose of this study was to investigate prognostic factors of clinical data and computed tomography (CT) findings in patients with NOMI.
This was a single institutional, retrospective study, reviewing 21 consecutive patients diagnosed with NOMI on angiography. Patients were divided into either ''survivor'' group or ''non-survivor'' group based on their clinical courses 1 month after diagnosis. Clinical information such as laboratory data, Charlson Comorbidity Index, and time from CT to injecting vasodilator was obtained from patients' medical records. Contrast-enhanced CT images were assessed in following items: defect of mural enhancement, pneumatosis intestinalis, hepatic portal venous gas, paralytic bowel dilatation, bowel wall thinning, and diameters of the relevant vessels.
Eight patients belonged to ''survivor'' group, whereas eleven were allocated to ''non-survivor'' group. None of CT findings showed significant difference between survivor group and non-survivor group [defect of mural enhancement: 75% and 100% (p = 0.16), pneumatosis intestinalis: 50% and 45.5% (p = 1.00), hepatic portal venous gas: 37.5% and 45.5% (p = 1.00), paralytic bowel dilatation: 12.5% and 63.6% (p = 0.06), and bowel wall thinning: 50% and 45.5% (p = 1.00)]. The diameters of the relevant vessels did not have significant difference either. Time from CT to injecting vasodilator was revealed to be significantly shorter in survivor group [187.5 (122.5-294) min and 310 (187-925.5)] (p = 0.048). None of the other clinical information had significant difference between each group.
Prompt angiography may be a key to improve the prognosis of NOMI patients.
非闭塞性肠系膜缺血（NOMI）是一种肠系膜缺血性疾病，其死亡率相当高，尽管人们对影响患者预后的因素知之甚少。本研究旨在探讨 NOMI 患者临床数据和计算机断层扫描（CT）结果的预后因素。
这是一项单中心回顾性研究，共纳入 21 例经血管造影诊断为 NOMI 的连续患者。根据诊断后 1 个月的临床病程，将患者分为“存活”组或“非存活”组。从患者病历中获取实验室数据、Charlson 合并症指数和从 CT 到注射血管扩张剂的时间等临床信息。评估增强 CT 图像的以下项目：壁强化缺陷、肠气肿、肝门静脉气肿、肠麻痹扩张、肠壁变薄和相关血管直径。
8 例患者属于“存活”组，11 例患者属于“非存活”组。存活组与非存活组 CT 表现无显著差异[壁强化缺陷：75%和 100%（p=0.16），肠气肿：50%和 45.5%（p=1.00），肝门静脉气肿：37.5%和 45.5%（p=1.00），肠麻痹扩张：12.5%和 63.6%（p=0.06），肠壁变薄：50%和 45.5%（p=1.00）]。相关血管的直径也没有显著差异。存活组从 CT 到注射血管扩张剂的时间明显更短[187.5（122.5-294）min 和 310（187-925.5）min]（p=0.048）]。各组间其他临床信息无显著差异。
及时血管造影可能是改善 NOMI 患者预后的关键。
