急性肠系膜动脉栓塞外科治疗的危险因素分析

Analysis of the Risk Factors of Acute Mesenteric Artery Embolism Patients with Surgical Treatment

摘要: 目的：分析影响急性肠系膜上动脉栓塞(acute mesenteric artery embolism, AMAE)外科治疗患者的危险因素，为提高早期诊治水平提供参考。方法：回顾性分析我院2001年1月至2018年1月39例AMAE外科手术患者的临床资料，死亡21例，治愈18例，分别设为死亡组与治愈组。比较两组患者性别、平均年龄、病程、是否有心血管合并症及栓塞位置等一般资料，比较坏死肠管长度，了解肠系膜切缘血管内血栓情况。结果：死亡组患者 ≥ 12 h病程的比例明显高于治愈组，近端血栓的发生率明显高于治愈组，肠管坏死长度也明显长于治愈组，差异有统计学意义(P < 0.05)。死亡组患者的年龄、性别及是否合并心血管疾病与治愈组差异无统计学意义(P > 0.05)。8例肠系膜切缘小动、静脉内存在微血栓。结论：病程超过12 h、肠系膜上动脉近端血栓的发生以及肠系膜切缘微血栓的存留是AMAE外科治疗的危险因素。做到早期诊断、早期治疗、保证肠系膜切缘的安全边际是提高AMAE治愈率的关键。

Abstract: Objective: To discuss the various factors affecting the prognosis of acute mesenteric artery embolism, and to provide guiding significance to raise the level of early diagnosis and treatment. Methods: The clinical data of 39 patients with acute mesenteric arterial embolism after operation in the Third Hospital of PLA from January, 2000 to January, 2018 was retrospectively analyzed. This study compares the patients’ age, sex, course of the disease, whether there is the merger cardiovascular disease and the thromboembolism location in death group and cure group, and compares the length of necrotic bowel and intravascular thrombosis in mesenteric cut edge. Results: The ration of clinical course (≥12 h) of death group was obviously higher than that of cured group, the position of the thromboembolism of death group was obviously higher than that of cured group, and the length of bowel necrosis of death group is significantly longer than that of cure group, the difference was statistically significant (P < 0.05). The age, gender and merger of cardiovascular disease of death group and those of cured group were compared respectively, there were no statistically significant difference (P > 0.05), there were 8 cases of micro thrombus within mesenteric cut edge. Conclusions: Course of more than 12 h, the happening of the proximal superior mesenteric artery thrombosis and mesenteric cut edge micro thrombus are risk factors of acute mesenteric artery embolism patients with surgical treatment. Early diagnosis, early treatment, and guarantee of mesenteric cut edge margin safety are the key to improve its cure rate of acute mesenteric artery embolism.