Ritz J P, Runkel N, Berger G, Buhr H J
Abteilung für Allgemein-, Gefäss- und Thoraxchirurgie, Universitätsklinikum Benjamin Franklin, FU Berlin.
Zentralbl Chir. 1997;122(5):332-8.
Between 1979 and 1995 we operated 141 (80 female/61 male) patients with acute mesenteric ischemia (AMI) in our department with a median age of 71.5 years. We found 107 arterial occlusions of the intestinal arteries, 16 patients with splanchnic vein thrombosis and 18 non-occlusive-AMI. We performed 46 bowel resections, 24 vascular interventions, 11 combinations of both and in 60 cases laparotomy alone. The mortality rate was 70.9% (75% in over 70 years old patients and 65% in under 70 years old patients). Acute mesenteric ischemia remains a disease with a high mortality between 60 and 80%. Prognostic factors include the time interval until surgical intervention, elevated WBC and serum-lactate level. The mortality rate is higher in elderly patients than in younger patients which is mainly due to delayed surgery in the elderly group. If surgery is performed early the survival rate increases independent of age. The most important prognostic factor and the only factor that can be influenced by the surgeon is the time interval between onset of symptoms and surgery. Therefore angiography or laparotomy should be performed as early as possible in cases of suspected AMI.
1979年至1995年间，我们科室共收治了141例急性肠系膜缺血（AMI）患者（女性80例/男性61例），中位年龄为71.5岁。我们发现107例存在肠动脉闭塞，16例为内脏静脉血栓形成，18例为非闭塞性AMI。我们实施了46例肠切除术、24例血管介入手术、11例两者联合手术，另有60例仅行剖腹探查术。死亡率为70.9%（70岁以上患者为75%，70岁以下患者为65%）。急性肠系膜缺血仍然是一种死亡率在60%至80%之间的高死亡率疾病。预后因素包括直至手术干预的时间间隔、白细胞升高和血清乳酸水平。老年患者的死亡率高于年轻患者，这主要是由于老年组手术延迟。如果早期进行手术，生存率会提高，与年龄无关。最重要的预后因素以及唯一可由外科医生影响的因素是症状出现至手术的时间间隔。因此，在疑似AMI的病例中应尽早进行血管造影或剖腹探查术。
