急性肠系膜缺血性疾病58例诊治分析

Diagnosis and treatment of 58 cases of acute mesenteric ischemia

关键词:  急性肠系膜缺血性疾病  诊断  手术治疗

Key words:  acute mesenteric ischemia  diagnosis  surgical treatment

摘要:

目的　分析急性肠系膜缺血性疾病（AMI）患者的临床资料，探讨急性肠系膜缺血性疾病的临床诊断和治疗。　方法　收集大连医科大学附属第二医院急腹症外科2005年1月至2015年1月收治的58例急性肠系膜缺血性疾病患者的临床资料。通过进行实验室检查、影像学检查等，分析患者的临床特征、诊断及治疗情况。　结果　58例患者在实验室检查中，白细胞升高比率为77.6%（45/58），中性粒细胞升高比率为74.1%（43/58），D-二聚体阳性率为52.8%（19/36）。在影像学检查中，B超检查的阳性率为36.6%（15/41），CT检查的阳性率为30.3%（17/56），CTA确诊率达94.1%（16/17），DSA的敏感性达到100%（8/8）。在本组资料中，首诊确诊率为44.8%（26/58），首诊误诊率55.2%（32/58）。40例（69.0%）患者手术治疗，手术治愈率72.5%（29/40），术后死亡率27.5%（11/40）。其余为保守或介入治疗。58例患者中，最终36例（62.1%）治愈出院，22例死亡，总死亡率37.9%。　结论　AMI缺乏典型的临床特征，虽然目前DSA及CTA检查的特异性及敏感性较好，但是总体诊断困难，死亡率高；早期诊断及选择合适的治疗方法是降低死亡率的关键。

Abstract:

Objective To investigate the clinical features, diagnosis and surgical treatment of acute mesenteric ischemia (AMI). 　Methods A retrospective analysis of AMI was performed by collecting clinical information of 58 patients, who were treated in the Second Affiliated Hospital of Dalian Medical University from January 2005 to January 2015. 　Results Investigation of laboratory data revealed elevation of WBC and neutrophil counts in 77.6% (45/58) and 74.1% (43/58) patients, respectively, and a D-dimmer positive rate of 52.8% (19/36). The positive diagnosis rate of Doppler ultrasound was 36.6% (15/41), and Computer Tomography 30.3% (17/56). While the positive diagnosis rate of CTA examination was 94.1% (16/17), and the sensitivity of the DSA was 100.0% (8/8). In the 58 cases, the rate of primary accurate diagnosis was 44.8% (26/58), while the misdiagnostic rate was 55.2% (32/58). Among them, 69.0% (40/58) of patients underwent surgical treatment, with 72.5% (29/40) cure rate and 27.5% (11/40) mortality rate. 　Conclusions AMI lacks typical clinical features. Despite the high specificity and sensitivity of CTA and DSA examination, AMI has high mortality rate and low diagnosis rate. The key to reduce mortality is early diagnosis and appropriate treatment.