Welch M, Baguneid M S, McMahon R F, Dodd P D, Fulford P E, Griffiths G D, Walker M G
Department of Vascular Surgery, Manchester Royal Infirmary and Medical School, UK.
Br J Surg. 1998 Aug;85(8):1095-8. doi: 10.1046/j.1365-2168.1998.00791.x.
Colonic ischaemia is a well documented complication of abdominal aortic reconstruction. In this prospective study patients had routine preoperative and postoperative colonoscopy and biopsy, in order to determine the true incidence and implications.
Fifty-six patients undergoing elective infrarenal aortic surgery, 28 for aneurysm and 28 for occlusive disease, had colonoscopy and biopsy before and 1 week after operation.
Colonic ischaemia was identified histologically in biopsies from 16 (30 per cent) of 53 patients. Almost half the patients had normal macroscopic appearances. Two factors exhibited a statistically significant association with the development of ischaemia: prolonged cross-clamp time (P < 0.05) and postoperative diarrhoea (P< 0.001). Co-morbidity was much higher in patients with colonic ischaemia (P< 0.005). Overall morbidity was significantly greater in the aneurysm group (P < 0.05).
Colonic ischaemia is common after aortic reconstruction. When suspected, colonoscopy with biopsy is diagnostic.
结肠缺血是腹主动脉重建术后一种有充分文献记载的并发症。在这项前瞻性研究中，患者接受了常规的术前和术后结肠镜检查及活检，以确定其真实发病率及影响因素。
56例接受择期肾下腹主动脉手术的患者，其中28例因动脉瘤，28例因闭塞性疾病，在手术前和术后1周接受了结肠镜检查及活检。
53例患者中有16例（30%）的活检组织在组织学上被确诊为结肠缺血。几乎一半的患者肉眼外观正常。有两个因素与缺血的发生存在统计学显著关联：较长的阻断时间（P < 0.05）和术后腹泻（P < 0.001）。结肠缺血患者的合并症发生率更高（P < 0.005）。总体发病率在动脉瘤组显著更高（P < 0.05）。
结肠缺血在主动脉重建术后很常见。如有怀疑，结肠镜检查及活检可用于诊断。
