Seiler C, Ris H B, Stirnemann P, Czerniak A
Department of Visceral and Transplantation Surgery, Inselspital Bern.
Swiss Surg. 1996(3):88-91.
Acute mesenteric ischemia (AMI) is still associated with a high mortality rate. Early diagnosis and treatment are mandatory since irreversible bowel damage occurs within a few hours of total ischemia. Reactive vasoconstriction, high postoperative vascular reocclusion rate and the release of toxic substances from the damaged bowel followed by bacterial translocation are all part of the disease process. A combined treatment plan for AMI devides to combat the unrelenting disease process on different levels involving early operation, perioperative intraarterial fibrinolytic and vasodilative treatment and anticoagulation, selective small bowel decontamination and mandatory second look operation is presented. The rationale of this concept and its successful outcome in a highly complex case are discussed.
急性肠系膜缺血（AMI）的死亡率仍然很高。由于在完全缺血的几小时内就会发生不可逆的肠损伤，因此早期诊断和治疗是必不可少的。反应性血管收缩、术后血管再闭塞率高以及受损肠管释放有毒物质并随后发生细菌移位，都是疾病过程的一部分。本文提出了一种针对AMI的联合治疗方案，旨在从不同层面应对这一顽固的疾病过程，包括早期手术、围手术期动脉内溶栓和血管扩张治疗以及抗凝治疗、选择性小肠去污和必要的二次探查手术。文中讨论了这一理念的基本原理及其在一个高度复杂病例中的成功结果。
