Cui Xinye, Chen Yu, Guan Guoxin, Luo Fuwen, Zhang Zhongtao
Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & State Key Lab of Digestive Health & National Clinical Research Center for Digestive Diseases, Beijing, P. R. China.
Department of General Surgery, The Second Affiliated Hospital, Dalian Medical University, Dalian, Liaoning, P. R. China.
Gastroenterol Rep (Oxf). 2025 Jul 7;13:goaf067. doi: 10.1093/gastro/goaf067. eCollection 2025.
Acute mesenteric ischemia (AMI) is a life-threatening vascular disorder that demands greater clinical and research attention due to its significant morbidity and mortality risks. Clinicians should maintain a high index of suspicion for AMI in patients presenting with severe abdominal pain disproportionate to physical findings, particularly those with atrial fibrillation or recent vasoconstrictor use. In such cases, prompt computed tomography angiography is recommended as the initial diagnostic modality, given its high sensitivity, specificity, efficiency, and favorable safety profile. Multi-disciplinary treatment plays a critical role in elucidating disease etiology and guiding therapeutic decision-making. For confirmed cases of intestinal necrosis, open surgical intervention remains the gold standard. Laparoscopic exploration offers a minimally invasive alternative for assessing bowel viability while reducing unnecessary surgical trauma in equivocal presentations. In the pre-necrotic phase of intestinal ischemia, emerging endovascular therapies demonstrate increasing promise due to their minimally invasive nature and improved clinical outcomes, warranting further investigation. Continuous clinical vigilance is essential throughout management. Persistent abdominal pain or signs of peritonitis may indicate disease progression, necessitating urgent reassessment for possible ischemic necrosis and therapeutic strategy adjustments. This review synthesizes current evidence by examining AMI pathophysiology, anatomical considerations, risk factors, and diagnostic-therapeutic advancements, with an emphasis on optimizing clinical decision-making in this critical condition.
急性肠系膜缺血（AMI）是一种危及生命的血管疾病，因其具有较高的发病率和死亡风险，需要更多的临床和研究关注。对于出现严重腹痛且与体格检查结果不相称的患者，尤其是患有心房颤动或近期使用血管收缩剂的患者，临床医生应高度怀疑AMI。在这种情况下，鉴于计算机断层扫描血管造影（CTA）具有高敏感性、特异性、效率和良好的安全性，建议将其作为初始诊断方法。多学科治疗在阐明疾病病因和指导治疗决策方面起着关键作用。对于确诊的肠坏死病例，开放手术干预仍然是金标准。腹腔镜探查为评估肠管活力提供了一种微创替代方法，同时减少了在不明确情况下不必要的手术创伤。在肠缺血的坏死前期，新兴的血管内治疗因其微创性质和改善的临床结果而显示出越来越大的前景，值得进一步研究。在整个治疗过程中，持续的临床警惕至关重要。持续性腹痛或腹膜炎体征可能表明疾病进展，需要紧急重新评估是否存在缺血性坏死并调整治疗策略。本综述通过研究AMI的病理生理学、解剖学因素、危险因素以及诊断治疗进展来综合当前证据，重点是优化在这种危急情况下的临床决策。
