急性肠系膜缺血102例诊治分析

摘要

目的 探讨急性肠系膜缺血(acute mesenteric ischemia,AMI)的诊断和治疗方法.方法 AMI病人102例,所有病人诊断明确后均行抗凝、扩管、溶栓等药物治疗,单纯保守治疗完全缓解者17例,其余85例病人在保守治疗48小时内效果不明显,63例转为腔内治疗,58例缓解,7例未缓解,5例转为手术治疗,2例放弃治疗;另22例直接转为开放手术治疗.评估102例病人药物治疗、腔内治疗、开放手术治疗的效果.结果 102例病人中,症状完全缓解92例,发生慢性肠功能不全5例,死亡3例,失访2例.结论 AMI病情凶险,提高对疾病的认识,早期诊断,尽早重建小肠血运是提高疗效的关键.腔内治疗是目前首选的治疗方案.%Objective To conclude the diagnostic and therapeutic experience for acute mesenter ic ischemia(AMI).Methods Clinical data of 102 AMI patients were analyzed retrospectively.The curative effect of conservative management,endovascular treatment and open surgery were evaluated.All patients were treated with anticoagulation,vasodilator,thrombolysis after the diagnosis was made.17 cases were relieved by simple medical therapy.The other 85 patients had no obvious effect within 48 hours after conservative treatment.Of the 63 cases undergone endovascular treatment,58 were relieved.Among other 7 unrelieved cases,2 of them gave up treatment and 5 patients were turned to open surgery.The left 22 cases were converted to open surgery directly.Results Of all 102 cases,92 patients were relieved completely,5 patients were turned to chronic intestinal dysfunction.3 patients died in hospital and 2 patients lost follow-up.Conclusion AMI is a potentially fatal vascular emergency.Early diagnosis by CTA and revascularization of intestine without delay is the pivotal management.Endovascular treatment is the preferred therapeutic options.