Surgical management of chronic intestinal ischemia: a reappraisal.
Surgical management of chronic intestinal ischemia: a reappraisal.
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慢性肠缺血的手术治疗：重新评估。
作者：
L. H. Hollier;P. E. Bernatz;P. Pairolero;Payne Ws;Philip J. Osmundson
五十六例慢性肠缺血患者接受了手术血运重建。所有患者都有腹痛，98%的患者体重明显减轻，75%的患者有腹部杂音。所有患者的内脏动脉闭塞性疾病均经血管造影证实; 77%的患者有多支血管闭塞性疾病，23%的患者有腹腔动脉或上级肠系膜动脉的单支血管受累。死亡率为8.9%。96%的幸存者症状完全缓解，但总体晚期复发率为26.5%。59%的患者接受了所有狭窄血管的血运重建。多支血管疾病的完全血运重建导致晚期复发率为11%。当三条狭窄血管中的两条接受血运重建时，复发率为29%，当三条狭窄血管中的一条接受血运重建时，复发率为50%。这些结果表明，虽然单支血管血运重建可能会缓解症状，但通过所有狭窄血管的完全血运重建可以获得最佳的长期结果。
Fifty-six patients with chronic intestinal ischemia underwent surgical revascularization. All patients had abdominal pain, 98% experienced significant weight loss, and 75% had an abdominal bruit. Visceral artery occlusive disease was documented by angiography in all patients; 77% of our patients had multiple-vessel occlusive disease, and 23% had single-vessel involvement of either the celiac or the superior mesenteric artery. The mortality rate was 8.9%. Ninety-six percent of the survivors were completely relief of symptoms, but an overall late recurrence rate was noted in 26.5%. Fifty-nine percent of our patients underwent revascularization of all stenotic vessels. Complete revascularization in multiple-vessel disease resulted in a late recurrence rate of 11%. When two of three stenotic vessels were revascularized, there was a 29% recurrence rate, and when one of three stenotic vessels was revascularized, there was a 50% recurrence rate. These findings suggest that although single-vessel revascularization may relieve symptoms, the optimal long-term result can be obtained by complete revascularization of all stenotic vessels.