Johnston K W, Lindsay T F, Walker P M, Kalman P G
Department of Surgery, Toronto Hospital, University of Toronto, Ontario, Canada.
Surgery. 1995 Jul;118(1):1-7. doi: 10.1016/s0039-6060(05)80002-9.
The purposes of this study were to determine the early and late results of placement of arterial bypass grafts in the treatment of chronic and acute intestinal ischemia and to ascertain whether multiple grafts provide better late results than a single graft.
Records of 34 patients who underwent mesenteric vascular graft placement were retrospectively reviewed.
All 21 patients with chronic ischemia had a history of intestinal angina and weight loss. Food fear was reported by 33% of patients; also, diarrhea in 57%, constipation in 29%, acalculous cholecystitis in 19%, ischemic gastritis or peptic ulcer in 19%, and elevation of liver enzymes in 22% were reported. Angiogram showed more than 50% stenosis or occlusion of the superior mesenteric artery (SMA) in 100% of patients, celiac artery in 90%, and inferior mesenteric artery in 90%. Although not described previously, a reduction in collateral flow from the internal iliac arteries was caused by severe pelvic disease in 56% of patients. There were no in-hospital deaths. The rate of survival at 1 year was 100%; at 2 years it was 93% +/- 6%, at 3 years 86% +/- 9%, at 5 years 79% +/- 11%, and at 10 years 50% +/- 15%. During follow-up, graft thrombosis occurred in three patients. Of the patients who underwent only a single SMA or celiac bypass, two of five died of bowel infarction; only one of 16 patients who underwent both celiac and SMA bypass had to undergo a repeat surgical procedure because of graft occlusion. Three of 16 retrograde bypasses thrombosed, compared with zero of five prograde bypasses. In nine patients who underwent placement of mesenteric bypass grafts because of acute ischemia caused by acute mesenteric thrombosis, the early mortality rate was 22%; the two deaths were the result of bowel ischemia. The cumulative survival rate was 78% +/- 14% at 1 month, 65% +/- 17% at 1 year, and 52% +/- 16% at 5 years. One of the two late deaths was due to graft thrombosis and bowel infarction. Three of four patients who underwent concomitant mesenteric bypass at the time of aneurysm repair or aortobifemoral bypass survived the surgical procedure.
When chronic and acute mesenteric ischemia are diagnosed and treated with a bypass graft, the early and late results are good. Complete revascularization of the SMA and celiac artery or pelvis or both and prograde bypass may reduce the risk of late bowel ischemia.
本研究的目的是确定动脉搭桥术治疗慢性和急性肠缺血的早期和晚期结果，并确定多支搭桥是否比单支搭桥能带来更好的晚期结果。
对34例行肠系膜血管搭桥术患者的记录进行回顾性分析。
所有21例慢性缺血患者均有肠绞痛和体重减轻病史。33%的患者有恐食症；此外，57%的患者有腹泻，29%有便秘，19%有非结石性胆囊炎，19%有缺血性胃炎或消化性溃疡，22%有肝酶升高。血管造影显示，100%的患者肠系膜上动脉（SMA）狭窄或闭塞超过50%，90%的患者腹腔动脉受累，90%的患者肠系膜下动脉受累。虽然此前未作描述，但56%的患者因严重盆腔疾病导致髂内动脉侧支血流减少。住院期间无死亡病例。1年生存率为100%；2年生存率为93%±6%，3年生存率为86%±9%，5年生存率为79%±11%，10年生存率为50%±15%。随访期间，3例患者发生移植血管血栓形成。在仅行单支SMA或腹腔动脉搭桥的患者中，5例中有2例死于肠梗死；在16例行腹腔动脉和SMA双搭桥的患者中，只有1例因移植血管闭塞而需再次手术。16例逆行搭桥中有3例发生血栓形成，而5例顺行搭桥中无1例发生。9例因急性肠系膜血栓形成导致急性缺血而行肠系膜搭桥术的患者，早期死亡率为22%；2例死亡是肠缺血所致。1个月时累积生存率为78%±14%，1年时为65%±17%，5年时为52%±16%。2例晚期死亡中有1例是由于移植血管血栓形成和肠梗死。4例在动脉瘤修复或主动脉双股动脉搭桥时同时行肠系膜搭桥的患者中，3例手术存活。
当诊断慢性和急性肠系膜缺血并采用搭桥术治疗时，早期和晚期结果良好。SMA和腹腔动脉或盆腔或两者的完全血运重建以及顺行搭桥可降低晚期肠缺血风险。
