Reichert Martin, Roller Fritz C, Kalder Johannes, Hecker Matthias, Bala Miklosh, Catena Fausto, Biffl Walter, Coccolini Federico, Moore Ernest E, Ansaloni Luca, Damaskos Dimitrios, Sartelli Massimo, Padberg Winfried, Hecker Andreas
Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Straße 7, 35392, Gießen, Deutschland.
Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Gießen, Klinikstraße 33, 35392, Gießen, Deutschland.
Chirurgie (Heidelb). 2023 Jul;94(7):608-615. doi: 10.1007/s00104-023-01913-x. Epub 2023 Jun 19.
Acute mesenteric ischemia is a severe illness, which if untreated, rapidly leads to a critical condition with sepsis, multiple organ failure and death in affected patients. The diagnosis and initiation of treatment of acute mesenteric ischemia should be performed as early and expeditiously as possible and follows the principle of the shortest possible time to reperfusion. Otherwise, the outcome of the patient rapidly deteriorates. The treatment algorithm should be adapted to the pathogenesis of the ischemia, the clinical condition and symptoms of the patients. With clinical signs of peritonitis, intestinal gangrene must be assumed and the abdomen should be surgically explored to detect and treat possible foci of sepsis at an early stage. The treatment of acute mesenteric ischemia should always be performed by an interdisciplinary team with all surgical and interventional options for intestinal revascularization as well as comprehensive intensive care medicine according to the standards of the Intestinal Stroke Center described in the literature. A short duration to revascularization and treatment in this interdisciplinary concept improves the outcome of patients with acute mesenteric ischemia. The World Society of Emergency Surgery provides expert consensus-based recommendations for the diagnosis and treatment of acute mesenteric ischemia; however, there is still a significant lack of broad high-quality evidence for this critical illness. Recommendations of the German specialist societies are urgently needed to ensure appropriate care, from the initial diagnostics to treatment and aftercare, for patients with suspected mesenteric ischemia in this country.
急性肠系膜缺血是一种严重疾病，若不治疗，受影响患者会迅速发展为脓毒症、多器官功能衰竭的危急状态并导致死亡。急性肠系膜缺血的诊断和治疗应尽早尽快进行，并遵循尽可能缩短再灌注时间的原则。否则，患者的病情会迅速恶化。治疗方案应根据缺血的发病机制、患者的临床状况和症状进行调整。出现腹膜炎临床体征时，必须考虑肠坏疽，应进行剖腹探查，以便早期发现并治疗可能的脓毒症病灶。急性肠系膜缺血的治疗应由多学科团队进行，采用文献中所述的肠道卒中中心标准，提供所有用于肠道血运重建的外科和介入选择以及全面的重症医学治疗。在这种多学科理念下，缩短血运重建和治疗时间可改善急性肠系膜缺血患者的预后。世界急诊外科学会为急性肠系膜缺血的诊断和治疗提供了基于专家共识的建议；然而，对于这种危急疾病，仍然严重缺乏广泛的高质量证据。迫切需要德国各专业学会提供建议，以确保为该国疑似肠系膜缺血患者从初步诊断到治疗及后续护理提供适当的治疗。
