Järvinen O, Laurikka J, Salenius J P, Lepäntalo M
Department of Surgery, Tampere University Hospital, Teiskontie 35, 33521 Tampere, Finland.
World J Surg. 1999 Mar;23(3):243-7. doi: 10.1007/pl00013190.
The present nationwide, multicenter clinical study was carried out in 26 departments of surgery to define the incidence and attendant mortality of intestinal infarction following abdominal aortic surgery, and to identify patients at risk of it. The data consist of 1752 patients who underwent abdominal aortic reconstruction during 1991-1993 as recorded in the Finnish national vascular registry (FINNVASC). Among the 1752 operations, 27 patients treated at 14 different hospitals had intestinal ischemia, and the complete patient records of all 27 cases were reanalyzed. The incidence of bowel infarction was 1.2%. Among patients operated on for a ruptured aneurysm it was 3.1%, whereas 1.0% of patients with nonruptured aneurysm and 0.6% of those operated on for aortoiliac occlusive disease developed intestinal infarction. In 14 patients (67%) the lesion affected the left colon. The overall 30-day mortality rate was 13% but reached 67% among those with intestinal infarction. We conclude that acute intestinal ischemia with bowel infarction is an infrequent but serious complication of abdominal aortic surgery. It is mainly related to surgery due to aneurysmal disease, and patients with occlusive aortoiliac disease present ischemic complications in the intestines less often. Hypotensive patients being treated for ruptured aneurysm are at greatest risk of intestinal ischemia.
本项全国性多中心临床研究在26个外科科室开展，旨在明确腹主动脉手术后肠梗死的发生率及相关死亡率，并识别有肠梗死风险的患者。数据来源于芬兰国家血管登记处（FINNVASC）记录的1991年至1993年期间接受腹主动脉重建术的1752例患者。在这1752例手术中，14家不同医院治疗的27例患者发生了肠缺血，对所有27例患者的完整病历进行了重新分析。肠梗死的发生率为1.2%。在因动脉瘤破裂接受手术的患者中，发生率为3.1%，而未破裂动脉瘤患者的发生率为1.0%，因主髂动脉闭塞性疾病接受手术的患者中发生率为0.6%。14例患者（67%）的病变累及左半结肠。总体30天死亡率为13%，但肠梗死患者的死亡率达到67%。我们得出结论，急性肠缺血伴肠梗死是腹主动脉手术中一种少见但严重的并发症。它主要与动脉瘤疾病手术相关，主髂动脉闭塞性疾病患者肠道缺血并发症较少见。因动脉瘤破裂接受治疗的低血压患者发生肠缺血的风险最大。
