Chronic mesenteric ischemia
Chronic mesenteric ischemia
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DOI：
10.1016/j.bpg.2004.11.002
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发表时间：
2005-04-01
影响因子：
3.2
通讯作者：
Sreenarasimhaiah, J
中科院分区：
文献类型：
--
作者：
Sreenarasimhaiah, J
慢性肠系膜缺血是一种罕见的，但重要的原因腹痛。虽然这种情况仅占所有肠缺血事件的5%，但它可能具有显著的临床后果。其病因众多，以动脉粥样硬化性闭塞或严重狭窄最为常见。这种疾病有一个无痛的过程，导致广泛的侧支血管形成。因此，当三条主要内脏血管中至少有两条受到影响时，就会出现症状。肠绞痛、体重减轻和厌食症是常见的临床特征。诊断通常可以通过非侵入性的方法，如计算机轴向断层血管造影，磁共振血管造影，和多普勒超声检查以及侵入性导管血管造影。慢性肠系膜缺血的治疗取决于血管病变的范围和部位。传统外科搭桥术的替代方法越来越普遍，包括栓子切除术、溶栓和经皮血管成形术和血管支架植入术。早期干预是至关重要的，因为这种疾病的自然过程可能会使人衰弱。此外，这有可能发展为危及生命的急性肠系膜缺血，随后发生肠梗死和死亡。长期研究表明，无症状但显著的肠系膜血管疾病发生症状的风险为86%，总体死亡率为40%。这一不寻常的，但重要的原因腹痛的认识和管理进行了详细讨论，在这篇评论。
Chronic mesenteric ischemia is an unusual but important cause of abdominal pain. Although this condition accounts for only 5% of all intestinal ischemic events, it can have significant clinical consequences. Among its many causes, atherosclerotic occlusion or severe stenosis is the most common. This disorder has an indolent course that results in extensive collateral vascular formation. Thus, symptoms occur when at least two of the three main splanchnic vessels are affected. Intestinal angina, weight loss, and sitophobia are common clinical features. Diagnosis can often be made by noninvasive methods such as computerised axial tomographic angiography, magnetic resonance angiography, and duplex ultrasonography as well as by invasive catheter angiography. Therapy of chronic mesenteric ischemia depends on the extent and location of vascular disease. Alternatives to traditional surgical bypass are becoming more common including embolectomy, thrombolysis, and percutaneous angioplasty with vascular stenting. Early intervention is vital as the natural course of this illness can be debilitating. Furthermore, this has potential to develop into life-threatening acute mesenteric ischemia with subsequent bowel infarction and death. Long-term studies have shown that the risk of developing symptoms from asymptomatic but significant mesenteric vascular disease is 86% with overall 40% mortality rate. The recognition and management of this unusual but important cause of abdominal pain is discussed in detail in this review.