急性肠系膜上动脉闭塞诊断及外科治疗进展.docVIP

急性肠系膜上动脉闭塞诊断及外科治疗进展 　　【中图分类号】R574 【文献标识码】A 【文章编号】1672－3783(2012)02－0008－01 　　【摘要】目的：探讨急性肠系膜上动脉（superior mesenteric artery，SMA）闭塞的诊断方法及外科治疗进展。方法：回顾性分析天津医科大学总医院2003年11月至2011年7月收治的36例该病患者的临床资料。结果：本组急性栓塞26例，急性血栓形成10例。其中手术治疗27例，行单纯SMA切开取栓术4例；单纯坏死肠段切除术10例；肠切除及取栓术11例；肠切除及血管旁路术1例；肠切除、取栓及血管旁路术1例，治愈13例，死亡14例。保守治疗9例，好转7例，死亡2例；总死亡率44.4%。20例随访期间，术后复发1例，经肠切除及SMA取栓术治愈，余经彩超证实均无SMA闭塞迹象。结论：早期诊断，早期恢复肠道供血仍是提高患者存活率的关键。基于计算机断层成像（computed tomographic angiography，CTA）及腔内技术的发展，杂交手术有望开辟治疗急性肠系膜上动脉闭塞的新途径。? 　　【关键词】肠系膜上动脉，闭塞，诊断，杂交手术? 　　Development of Diagnosis and Surgical Treatment in Acute Superior Mesenteric Artery Occlusion ? 　　Lu meng , Dai xiangchen , Luo yudong ? 　　【Abstract】Objective: To explore the new development of diagnosis and surgical treatment of acute superior mesenteric artery occlusion. Methods: Retrospectively analyse the clinical data of 36 cases of inpatients with acute superior mesenteric artery occlusion in Tianjin Medical University General Hospital from Nov. 2003 to Jul. 2011. Results: Among the team, acute superior mesenteric artery embolism 26 cases, acute superior mesenteric artery thrombosis 10 cases. 27 cases by surgical therapy: purely embolectomy 4 cases; purely resection of necrotic intestine 10 cases; resection of intestine and embolectomy 11 cases; resection of intestion and artery bypass operation 1 case ;resection of intestine, embolectomy and artery bypass operation 1 case.13 cases healed,14 cases died. Expectant treatment 9 cases, 7 cases got better, 2 cases died, general mortality rate 44.4%. During the follow-up period of 20 cases, 1 post-operation case recurred, and cured by resection of intestine and embolectomy, there were no evidence of recurrence by color Dopplor flow imaging in other cases. Conclusion: Early diagnosis and early restoration of bowel blood supply is still the key to improve the survival rate of the patients. Based on rapid development of computed tomographic angiography and endovascular techniques, a new hybrid endovascular-sur