Vrba R, Řezáč T, Špička P, Klos D, Černá M, Köcher M
Department of Surgery I, University Hospital Olomouc, Zdravotníku 248/7, Olomouc, 77900, Czech Republic.
Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hněvotínská 976/3, Olomouc, 77515, Czech Republic.
Sci Rep. 2025 Jan 2;15(1):74. doi: 10.1038/s41598-024-84026-7.
Acute mesenteric ischaemia (AMI) is a sudden onset of impaired bowel perfusion. Has a high mortality rate and is difficult to diagnose. Therapy involves endovascular, surgical, or a combination of both. Because of baseline differences, the comparison between endovascular and open surgical treatment is subject to selection bias. The aim of this study was to evaluate the results of treatment of AMI by open or endovascular approach in combination with laparotomy, and evaluation of treatment strategy in similar situations. Clinical data from 21 patients treated for AMI between 2018 and 2022 were retrospectively reviewed and compared. The primary endpoint of the study was in-hospital mortality. The secondary endpoint was the statistical evaluation of risk factors for mortality. All patients underwent acute endovascular revascularisation. Aspiration thromboembolectomy was performed in nine patients, stenting in seven, PTA in one and surgery in three. Endovascular therapy was unsuccessful for technical reasons in 3 patients. None of the monitored parameters reached statistical significance. The best results were achieved in the early diagnosis group. The overall mortality of acute mesenteric ischaemia in our cohort was 34.8%. Acute mesenteric ischaemia is a serious condition affecting mainly elderly patients with a high mortality rate, but the diagnosis of mesenteric ischaemia is not an automatic death sentence. To achieve the best therapeutic outcome, mesenteric ischaemia needs to be diagnosed and treated at an early stage. The best therapeutic outcomes are achieved in centres with 24-hour access to endovascular revascularisation and surgical therapy.
急性肠系膜缺血（AMI）是一种肠灌注突然受损的疾病。死亡率高且难以诊断。治疗方法包括血管内治疗、手术治疗或两者结合。由于基线差异，血管内治疗与开放手术治疗之间的比较存在选择偏倚。本研究的目的是评估开放或血管内治疗联合剖腹手术治疗AMI的结果，以及评估类似情况下的治疗策略。回顾性分析并比较了2018年至2022年间21例接受AMI治疗患者的临床资料。本研究的主要终点是住院死亡率。次要终点是对死亡危险因素进行统计学评估。所有患者均接受了急性血管内血运重建。9例患者进行了抽吸血栓切除术，7例患者进行了支架置入术，1例患者进行了经皮腔内血管成形术（PTA），3例患者进行了手术。3例患者因技术原因血管内治疗失败。所有监测参数均未达到统计学显著性。早期诊断组取得了最佳结果。我们队列中急性肠系膜缺血的总体死亡率为34.8%。急性肠系膜缺血是一种主要影响老年患者的严重疾病，死亡率高，但肠系膜缺血的诊断并非必然宣判死刑。为了获得最佳治疗效果，肠系膜缺血需要在早期进行诊断和治疗。在能够24小时进行血管内血运重建和手术治疗的中心可取得最佳治疗效果。
