Ward D, Vernava A M, Kaminski D L, Ure T, Peterson G, Garvin P, Arends T W, Longo W E
Department of Surgery, St. Louis University School of Medicine, Missouri, USA.
Am J Surg. 1995 Dec;170(6):577-80; discussion 580-1. doi: 10.1016/s0002-9610(99)80019-1.
The factors associated with outcome of patients with nonocclusive mesenteric ischemia are poorly defined.
Over a 7-year period, 34 consecutive patients with nonocclusive mesenteric ischemia were identified.
The mean age of the study patients was 63 years (range 31 to 94); 21 of 34 (62%) were men. The mean delay in diagnosis was 31 hours (range 7 hours to 6 days). Seven of 34 (21%) underwent preoperative visceral arteriography. Two of these 7 required surgery, and both died as a result of intestinal infarction. The remaining 27 had the diagnosis made at celiotomy. Among the 29 who were explored, 16 of 29 (55%) had intestinal infarction. Twenty-one of 29 (72%) had segmental bowel injury whereas 8 of 29 (28%) had massive injury. Among those with segmental infarction, primary anastomosis was performed in 12 of 21 patients (57%); 5 of the 12 (42%) died. Nine of 21 patients (43%) underwent delayed anastomosis; 2 of the 9 (22%) died. No patient with massive injury underwent primary anastomosis. Second-look laparotomy was performed on 22 of 29 (76%). Eleven of those 22 (50%) had a further bowel resection. Overall, 16 of 29 (55%) who underwent surgery for nonocclusive mesenteric ischemia are alive.
Improved survival from nonocclusive mesenteric ischemia is dependent upon the identification of high-risk groups, aggressive reexploration, and delayed intestinal anastomosis.
与非闭塞性肠系膜缺血患者预后相关的因素尚不明确。
在7年期间，共确定了34例连续的非闭塞性肠系膜缺血患者。
研究患者的平均年龄为63岁（范围31至94岁）；34例中有21例（62%）为男性。诊断的平均延迟时间为31小时（范围7小时至6天）。34例中有7例（21%）术前行内脏动脉造影。这7例中有2例需要手术，且均因肠梗死死亡。其余27例在剖腹手术时确诊。在接受探查的29例中，29例中有16例（55%）发生肠梗死。29例中有21例（72%）有节段性肠损伤，而29例中有8例（28%）有大面积损伤。在节段性梗死患者中，21例患者中有12例（57%）进行了一期吻合；12例中有5例（42%）死亡。21例患者中有9例（43%）进行了延迟吻合；9例中有2例（22%）死亡。没有大面积损伤的患者进行一期吻合。29例中有22例（76%）进行了二次剖腹探查。这22例中有11例（50%）再次进行了肠切除术。总体而言，因非闭塞性肠系膜缺血接受手术的29例中有16例（55%）存活。
提高非闭塞性肠系膜缺血的生存率取决于识别高危人群、积极再次探查和延迟肠吻合。
