Casey K M, Quigley T M, Kozarek R A, Raker E J
Department of Surgery, Virginia Mason Medical Center, Seattle, Washington.
Am J Surg. 1993 May;165(5):646-9. doi: 10.1016/s0002-9610(05)80453-2.
Gastropathy on the basis of mesenteric arterial ischemia can be masked in presentation as the typically more benign entities of gastritis, gastric ulceration, or gastric atony. Gastritis and ulceration are commonly associated with stress, hyperacidity, Helicobacter pylori infection, or medication injury. Gastric atony is less commonly seen and usually attributable to diabetes mellitus, vagotomy, or mechanical gastric outlet obstruction. Gastric ischemia as a cause of gastropathy is an underappreciated phenomenon with a particularly poor prognosis in which early diagnosis is essential to potentially successful intervention. Seven patients with ischemic gastropathy are described; all are women, aged 41 to 71 years, smokers, with hypertension. Nausea, vomiting, weight loss, and gastrointestinal bleeding were the common presenting symptoms. All patients had endoscopic or autopsy-proven gastric ulcerations or necrosis, and two patients had proven gastroparesis. Four of five patients with ischemic gastritis died within 3 months of diagnosis despite vascular reconstruction. The two patients with gastroparesis underwent aorto-celiac bypass and are well 9 and 20 months, respectively, after operation. Treatment results were distressingly unsatisfactory, especially in those patients in whom gastritis rather than gastroparesis was the presenting problem. Although the high mortality of mesenteric ischemia is well described, little documentation of gastric ischemia exists in the literature. This entity is generally not considered in the differential diagnosis of gastritis, ulceration, or gastroparesis. Empirically, an early diagnosis and treatment may improve the survival in this select patient group.
基于肠系膜动脉缺血的胃病在临床表现上可能被掩盖，表现为通常更为良性的胃炎、胃溃疡或胃无力。胃炎和溃疡通常与应激、胃酸过多、幽门螺杆菌感染或药物损伤有关。胃无力较少见，通常归因于糖尿病、迷走神经切断术或机械性胃出口梗阻。胃缺血作为胃病的一个病因是一种未得到充分认识的现象，预后特别差，早期诊断对于可能成功的干预至关重要。本文描述了7例缺血性胃病患者；均为女性，年龄41至71岁，吸烟者，患有高血压。恶心、呕吐、体重减轻和胃肠道出血是常见的临床表现。所有患者经内镜检查或尸检证实有胃溃疡或坏死，2例患者经证实有胃轻瘫。5例缺血性胃炎患者中有4例在诊断后3个月内死亡，尽管进行了血管重建。2例胃轻瘫患者接受了腹主动脉-腹腔干搭桥手术，术后分别9个月和20个月情况良好。治疗结果令人沮丧地不尽人意，尤其是那些以胃炎而非胃轻瘫为主要问题的患者。尽管肠系膜缺血的高死亡率已有充分描述，但文献中关于胃缺血的记载很少。在胃炎、溃疡或胃轻瘫的鉴别诊断中，通常不考虑这一病症。根据经验，早期诊断和治疗可能会提高这一特定患者群体的生存率。
