急性肠系膜缺血性疾病36例治疗体会

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：回顾性收集并分析36 例AMI患者的临床资料，均术前行MDT讨论，血管外科及胃肠外科联合手术治疗。所有治疗病例均行手术探查。其中3例病人术中使用荧光内镜判断肠道血供。统计诊治过程中腹部CT、白细胞计数、D-二聚体相关数据，应用SPSS软件分析其与肠道坏死的相关性。结果：腹部CT特异表现、白细胞计数升高与肠道坏死有相关性关系。治疗病例有11例行肠切除、 8例为外院行手术治疗后，在我院行术后康复治疗。术后8例发生短肠综合证。1例病人自动出院。1例死亡。1例病人术后出现肠道坏死、肠瘘，3个月后行肠瘘切除术，术后恢复良好。5例病人术后6个月行造口还纳。荧光内镜判断肠道血供及生机效果良好。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、改善预后的关键。多学科讨论后精准治疗，可提高治疗效果。术前腹部CTA对AMI的诊断及判断肠道坏死有重要意义。术中使用吲哚箐绿荧光显影剂、配合荧光导航内镜，判断肠道缺血范围，值得进一步探讨。临时性肠道双造瘘有利于及时发现肠管血运恢复情况，远端造瘘可早期进行肠内营养，值得推广。

Experience in the Treatment of 36 Cases of Acute Mesenteric Ischemic Disease

ABSTRACT Objective: To investigate the diagnosis and treatment of acute mesenteric ischemia (AMI). Methods: Clinical data of 36 patients with AMI were collected and analyzed retrospectively. All patients were treated with MDT, vascular surgery and gastrointestinal surgery. Surgical exploration was performed in all treated cases. Intraoperative fluorescence endoscopy was used to determine intestinal blood supply in 3 patients. The relevant data of abdominal CT, white blood cell count and D-dimer during the diagnosis and treatment were counted, and the correlation between them and intestinal necrosis was analyzed by SPSS software. Results: The specific features of abdominal CT and the increase of white blood cell count were correlated with intestinal necrosis. Among the treated patients, 11 underwent intestinal resection and 8 underwent postoperative rehabilitation therapy in our hospital after surgical treatment in another hospital. Postoperative short bowel syndrome occurred in 8 cases. 1 patient was discharged automatically. One death occurred. Postoperative intestinal necrosis and intestinal fistula occurred in 1 patient. 3 months later, the patient underwent intestinal fistula resection, and the postoperative recovery was good. Five patients underwent ostomy for retraction 6 months after operation. Fluorescent endoscopy showed good results in determining intestinal blood supply and vitality. Conclusion: AMI is a dangerous disease, improving the understanding of the disease, early diagnosis, early reconstruction of small intestinal blood circulation is the key to improve the efficacy and prognosis. Precision therapy after multidisciplinary discussion can improve the therapeutic effect. Preoperative abdominal CTA has important significance for the diagnosis of AMI and the judgment of intestinal necrosis. Intraoperative use of indoliclegreen fluorescent imaging agent, coupled with fluorescence navigation endoscopy, to determine the extent of intestinal ischemia, it is worth further discussion. Double abdominal wall ostomy is conducive to timely detection of intestinal blood supply recovery, and distal ostomy can be used for early enteral nutrition, which is worthy of promotion.