Watada Susumu, Obara Hideaki, Okui Jun, Hosokawa Kyosuke, Matsubara Kentaro, Harada Hirohisa, Fujimura Naoki, Fujii Taku, Shimogawara Tatsuya, Kitagawa Yuko
Department of Surgery Kawasaki Municipal Hospital Kawasaki Japan.
Department of Surgery Keio University School of Medicine Tokyo Japan.
Ann Gastroenterol Surg. 2022 Aug 18;7(1):175-181. doi: 10.1002/ags3.12614. eCollection 2023 Jan.
This study aimed to predict cases of acute superior mesenteric artery (SMA) occlusion requiring bowel resection using occlusion site and time from symptom onset to diagnosis at five Japanese institutions. Advances in imaging, endovascular treatment, and perioperative management have improved the clinical outcomes of patients with acute SMA occlusion; however, in clinical practice it remains difficult to effectively determine patients requiring bowel resection.
We retrospectively analyzed the data of 48 patients (mean age: 82.5 y; male: 37.5%) diagnosed with acute SMA occlusion between June 2009 and August 2018. Background data of patients who required and did not require bowel resection were compared. A multivariable predictive model was developed using the time from symptom onset to diagnosis and whether SMA occlusion was proximal, including the origin of the middle colic artery.
Fifteen patients (31.3%) died during the hospital stay. Atrial fibrillation (83.3%) was the most common comorbidity. The median time from symptom onset to diagnosis was 13.0 (interquartile range, 4.75-24.0) h. Laparotomy, bowel resection, and thrombus embolectomy were performed in 41 (85.4%), 26 (54.2%), and 21 (43.8%) patients, respectively. A logistic regression model achieved 78.6% sensitivity in predicting cases not requiring bowel resection. Proximal occlusion was significantly associated with the requirement for bowel resection ( = .039).
The time from symptom onset to diagnosis and occlusion site contributed to high sensitivity in determining the need for bowel resection in patients with acute SMA occlusion. Further prospective studies are warranted to investigate the clinical impact of this model.
本研究旨在利用日本五家机构的闭塞部位以及从症状出现到诊断的时间，预测需要进行肠切除的急性肠系膜上动脉（SMA）闭塞病例。成像技术、血管内治疗和围手术期管理的进展改善了急性SMA闭塞患者的临床结局；然而，在临床实践中，有效确定需要进行肠切除的患者仍然很困难。
我们回顾性分析了2009年6月至2018年8月期间诊断为急性SMA闭塞的48例患者（平均年龄：82.5岁；男性：37.5%）的数据。比较了需要和不需要进行肠切除的患者的背景数据。使用从症状出现到诊断的时间以及SMA闭塞是否为近端（包括结肠中动脉的起源）建立了多变量预测模型。
15例患者（31.3%）在住院期间死亡。心房颤动（83.3%）是最常见的合并症。从症状出现到诊断的中位时间为13.0（四分位间距，4.75 - 24.0）小时。分别有41例（85.4%）、26例（54.2%）和21例（43.8%）患者进行了剖腹手术、肠切除和血栓栓子切除术。逻辑回归模型在预测不需要进行肠切除的病例时灵敏度达到78.6%。近端闭塞与肠切除的需求显著相关（P = 0.039）。
从症状出现到诊断的时间以及闭塞部位有助于在确定急性SMA闭塞患者是否需要进行肠切除时获得高灵敏度。有必要进行进一步的前瞻性研究来调查该模型的临床影响。
