摘要
目的总结急性肠系膜血管缺血的诊断和治疗经验,分析损伤控制性手术的应用价值。方法搜集54例急性肠系膜血管缺血患者,根据术前肠系膜血管的CTA检查和术中探查情况,采取全身抗凝、血管支架、插管溶栓等序贯治疗方案,出现急性腹膜炎作为手术探查的适应证。结果本组6例患者放弃治疗,9例全身抗凝治疗后病情好转,6例血管腔内支架治疗后治愈或好转,13例通过肠系膜上动脉行插管溶栓治疗。20例接受手术治疗的患者中9例采用了损伤控制外科方法(包括术中尽量缩短手术时间,肠管远近端外置,补片暂时性关腹等),11例常规手术治疗。本组总死亡率18.5%(10/54),手术死亡率20%(4/20),手术并发症发生率为45%(9/20),损伤控制外科组和常规治疗组死亡率分别为1/9和3/11(P>0.05),其并发症发生率分别为3/9和10/11(P<0.05)。结论CTA可作为大多数病例确诊的首选检查和诊断依据,序贯性治疗可降低本病的死亡率,而损伤控制性手术可有效减少其手术并发症。
Objective To summarize the experience of diagnosis and management of acute mesenteric ischemia （AMI）, and appraise the value of damage control surgery. Methods Fifty-four patients of AMI admitted to General Hospital of PLA from 2002 to 2008 were involved in the study, and sequential therapy （systemic anticoagulation, intravascular stent treatment, catheter thrombolysis, etc. ） was given to the patients according to the findings of CT angiography （CTA） of mesenteric vessels and laparotomy exploration. The indication of exploratory laparotomy was the appearance of signs of acute peritonitis. Results Of the 54 cases, 6 abandoned treatment and died, 9 re ceived systemic anticoagulation, 6 received intravascular stent treatment, 13 received catheter thrombolysis via superior mesenteric artery, and 20 received surgical intervention （9 with damage control surgery and 11 with conventional operation）. The mortality of AM/in this study was 18. 51% （10/54）, and that of the 20 patients who received laparotomy was 20% （4/20）, and the incidence of operative complication was 45% （9/20）. The mortality of patients with damage control surgery and conventional operation was 1/9 and 3/11 respectively （P〉0. 05）, and the complication rate was 3/9 and 10/11 respectively （P〈0. 05）. Conclusions CT angiography can be used as the first choice of examination and diagnostic basis in most cases of AMI, sequential therapy can decrease the mortality of this disease, and damage control surgery can improve the safety and decrease the incidence of complication effectively.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2009年第4期409-411,共3页
Medical Journal of Chinese People's Liberation Army
