Meyer T, Klein P, Schweiger H, Lang W
Chirurgische Klinik und Poliklinik, Universität Erlangen-Nürnberg.
Zentralbl Chir. 1998;123(3):230-4.
Acute mesenteric ischemia is difficult to diagnose and is combined with a high mortality. In a retrospective analysis it was investigated how to improve the poor prognosis of the disease.
Between January 1988 through December 1994 a total of 46 patients were operated on for acute mesenteric ischemia. Mesenteric artery occlusion was present in three quarters of the cases (n = 35). These were analysed according to symptoms, diagnosis, mechanism of occlusion, operative procedure and prognosis. Distribution of gender was almost balanced (19 women, 16 men) with a median age of 70.5 years.
Embolic arterial occlusion was predominant (n = 22). Most frequently, the superior mesenteric artery was exclusively concerned (n = 22). Serum levels of lactate and leucocytes were preoperatively elevated in over 90% (median values: lactate 53 U/l, leucocytes 15050/ml). In 16 patients diagnosis was made on the ground of clinical parameters and/or angiography, but 19 patients were not diagnosed until operation. 19 patients were operated within 6 hours, 12 patients within 24 hours after admission (> 24 hours: n = 4). Vascular reconstructive procedures only, such as thrombectomy and/or aortomesenteric bypass were performed in 9 cases, in a further 7 cases combined with bowel resection. Bowel resection alone was done in 7 patients, 12 patients had only diagnostic laparotomy. 13 patients survived, 10 of them had been treated with vascular reconstruction.
Acute mesenteric ischemia ought to be suspected in every patient with uncertain abdominal pain, because only early diagnosis can improve prognosis. Measurement of serum lactate is diagnostically helpful, although not proving. In case of elevated lactate levels and uncertain abdominal symptoms angiography of the mesenteric vessels should be performed early. At operation, blood flow in the mesenteric arteries should be restored whenever possible.
急性肠系膜缺血难以诊断，且死亡率高。通过一项回顾性分析，研究如何改善该病的不良预后。
1988年1月至1994年12月期间，共有46例患者因急性肠系膜缺血接受手术。四分之三的病例（n = 35）存在肠系膜动脉闭塞。根据症状、诊断、闭塞机制、手术方式及预后对这些病例进行分析。性别分布几乎平衡（19名女性，16名男性），中位年龄为70.5岁。
栓塞性动脉闭塞最为常见（n = 22）。最常累及的是肠系膜上动脉（n = 22）。术前超过90%的患者血清乳酸和白细胞水平升高（中位值：乳酸53 U/l，白细胞15050/ml）。16例患者根据临床参数和/或血管造影确诊，但19例患者直到手术时才被诊断出来。19例患者在入院后6小时内接受手术，12例在24小时内接受手术（> 24小时：n = 4）。9例患者仅进行了血管重建手术，如血栓切除术和/或主动脉肠系膜旁路手术，另外7例患者同时进行了肠切除术。7例患者仅进行了肠切除术，12例患者仅进行了诊断性剖腹探查术。13例患者存活，其中10例接受了血管重建治疗。
每一位腹痛原因不明的患者都应怀疑有急性肠系膜缺血，因为只有早期诊断才能改善预后。血清乳酸测定虽不能确诊，但有助于诊断。如果乳酸水平升高且腹部症状不明确，应尽早进行肠系膜血管造影。手术时，应尽可能恢复肠系膜动脉的血流。
