Maulini Marie, Yan David Jun, Buchs Nicolas, Nendaz Mathieu
Service de médecine interne générale, HUG, 1211 Genève 14.
Service de radiologie, HUG, 1211 Genève 14.
Rev Med Suisse. 2020 Oct 21;16(711):1974-1979.
Acute mesenteric ischemia is a rare diagnosis with a very high mortality rate. It is often suspected in case of severe abdominal pain, disproportional to the findings of physical examination. The definite diagnosis is confirmed by CT-angiography and surgical exploration, but the measurement of blood L-lactate often takes place during the diagnostic work-up when this pathology is suspected. This review shows that there is no biological marker with sufficient sensitivity and specificity to confirm or rule out acute mesenteric ischemia. L-lactate measurement is easy to perform, but its diagnostic performance is insufficient to avoid a CT-angiography, whatever the pre-test clinical probability of acute mesenteric ischemia. These conclusions are supported by the current recommendations of the World Society of Emergency Surgery.
急性肠系膜缺血是一种罕见的诊断，死亡率极高。在出现严重腹痛且与体格检查结果不相称的情况下，常常会怀疑该病。通过CT血管造影和手术探查可确诊，但在怀疑有这种病症时，通常会在诊断检查过程中进行血L-乳酸测定。本综述表明，不存在具有足够敏感性和特异性来确诊或排除急性肠系膜缺血的生物标志物。L-乳酸测定操作简便，但其诊断性能不足以避免进行CT血管造影，无论急性肠系膜缺血的检测前临床概率如何。世界急诊外科学会的当前建议支持了这些结论。
