Kühn Florian, Schiergens Tobias S, Klar Ernst
Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilian University of Munich, Munich, Germany.
Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany.
Visc Med. 2020 Aug;36(4):256-262. doi: 10.1159/000508739. Epub 2020 Aug 4.
Despite constant improvements in diagnostic as well as interventional and surgical techniques, acute mesenteric ischemia (AMI) remains a life-threatening emergency with high mortality rates. The time to diagnosis of AMI is the most important predictor of patients' outcome; therefore, prompt diagnosis and intervention are essential to reduce mortality in patients with AMI. The present review was performed to analyze potential risk factors and to help find ways to improve the outcome of patients with AMI.
Whereas AMI only applies to approximately 1% of all patients with an "acute abdomen," its incidence is rising up to 10% in patients >70 years of age. The initial clinical stage of AMI is characterized by a sudden onset of strong abdominal pain followed by a painless interval. Depending on the extent of disease, the symptoms of nonocclusive mesenteric ischemia (NOMI) and patients with a venous thrombosis can be very different from those of acute occlusive ischemia. Biphasic contrast-enhanced CT represents the gold standard for the diagnosis of arterial and venous occlusion. In case of a central occlusion of the superior mesenteric artery or signs of peritonitis, immediate surgery should be performed. If major bowel resection becomes necessary, critical residual intestinal length limits must be kept in mind. Endovascular techniques for arterial occlusion have taken on a much greater importance today. For stable patients with NOMI, interventional catheter angiography is recommended because it enables diagnosis and treatment with selective application of vasodilators. Depending on its degree, interventional treatment with a transhepatic catheter lysis should be considered for acute and chronic portal vein thrombosis.
The prompt and targeted use of the appropriate diagnostics and interventions appears to be the only way to reduce the persistently high mortality rates for AMI.
尽管诊断以及介入和手术技术不断改进，但急性肠系膜缺血（AMI）仍然是一种危及生命的紧急情况，死亡率很高。AMI的诊断时间是患者预后的最重要预测因素；因此，及时诊断和干预对于降低AMI患者的死亡率至关重要。本综述旨在分析潜在风险因素，并帮助找到改善AMI患者预后的方法。
虽然AMI仅适用于所有“急腹症”患者中的约1%，但其发病率在70岁以上患者中高达10%。AMI的初始临床阶段表现为突然发作的剧烈腹痛，随后是无痛期。根据疾病程度，非闭塞性肠系膜缺血（NOMI）和静脉血栓形成患者的症状可能与急性闭塞性缺血患者的症状非常不同。双期对比增强CT是诊断动脉和静脉闭塞的金标准。如果肠系膜上动脉发生中央闭塞或出现腹膜炎体征，应立即进行手术。如果必须进行大范围肠切除，必须牢记关键的剩余肠长度限制。如今，动脉闭塞的血管内技术变得更加重要。对于稳定的NOMI患者，建议进行介入性导管血管造影，因为它能够通过选择性应用血管扩张剂进行诊断和治疗。对于急性和慢性门静脉血栓形成，应根据其程度考虑经肝导管溶栓的介入治疗。
及时且有针对性地使用适当的诊断方法和干预措施似乎是降低AMI持续高死亡率的唯一途径。
