Current results of surgical therapy for chronic mesenteric ischemia.

Current results of surgical therapy for chronic mesenteric ischemia.
复制标题

慢性肠系膜缺血手术治疗的最新结果。

DOI：
--
复制
发表时间：
1997
期刊：
Archives of Surgery
影响因子：
--
通讯作者：
Bruce L. Gewertz
Bruce L. Gewertz
中科院分区：
--
文献类型：
--
作者：
J. Moawad;J. Mckinsey;Charles W. Wyble;H. Bassiouny;Lewis B. Schwartz;Bruce L. Gewertz

文献摘要

参考文献

被引文献

相似文献

背景 尽管近年来对慢性肠系膜缺血的认识有所增加，但这种疾病仍然存在诊断和治疗挑战。 目的 探讨外科血运重建术治疗慢性肠系膜缺血的现代结果。 设计 回顾性审查。 设置 大学医疗中心 患者 回顾了1986年至1996年期间接受慢性肠系膜缺血手术治疗的24例连续患者（平均+/- SEM年龄，58 +/- 3岁; 5例男性，19例女性）的管理。 干预 外科肠系膜血管重建术。 主要观察指标 术后病程、长期移植物通畅率和长期无瘤生存率。 结果 最常见的症状是餐后腹痛（18例患者[75%]）和体重减轻（14例患者[58%]）。不太具体的主诉包括恶心和呕吐（8例患者[33%]）、腹泻（7例患者[29%]）和便秘（4例患者[17%]）。动脉粥样硬化风险因素常见，包括吸烟（20例患者[83%]）、冠状动脉疾病（10例患者[42%]）和高血压（10例患者[42%]）。21例患者的病因被确定为动脉粥样硬化，2例同卵双胞胎患者的正中弓状韧带压迫，1例患者的大动脉炎。8例患者的病变位于所有3条主要内脏血管（腹腔动脉、上级肠系膜动脉[SMA]和肠系膜下动脉），13例患者的病变位于腹腔动脉和SMA，2例患者仅位于SMA，1例患者的病变位于SMA和肠系膜下动脉。17例患者接受了从腹腔上主动脉到SMA和/或腹腔动脉的顺行重建; 7例患者通过使用源自肾下主动脉或人工移植物的逆行旁路进行了血运重建。无围手术期死亡，但1例患者在早期移植物衰竭和脓毒症后6周在医院死亡（总住院死亡率为4%）。随访时间为3个月至10年（中位数为2.4年）。24例患者中的19例通过使用造影剂血管造影或双功扫描客观记录的平均+/- SEM 5年一期移植物通畅率为78% +/-11%。3例患者（3周、5个月和7个月时）记录了原发性失败。2例患者需要血栓切除术;其中1例患者随后死于肠梗死。使用寿命表分析的平均+/- SEM 5年生存率为71% +/-11%。没有移植物通畅的患者出现症状性复发。 结论 慢性肠系膜缺血通常是晚期系统性动脉粥样硬化的表现。症状几乎总是反映SMA分布中的中肠缺血。从腹腔上主动脉行顺行旁路术的手术并发症可接受，是目前首选的重建技术。手术血运重建为大多数慢性肠系膜缺血患者提供了长期无瘤生存。
BACKGROUND Although recognition of chronic mesenteric ischemia has increased in recent years, this disorder has continued to present diagnostic and therapeutic challenges. OBJECTIVE To examine the modern results of surgical revascularization for chronic mesenteric ischemia. DESIGN Retrospective review. SETTING University medical center. PATIENTS The management of 24 consecutive patients (mean +/- SEM age, 58 +/- 3 years; 5 men, 19 women) who were undergoing surgical treatment of chronic mesenteric ischemia between 1986 and 1996 was reviewed. INTERVENTION Surgical mesenteric revascularization. MAIN OUTCOME MEASURES Postoperative course, long-term graft patency rate, and long-term symptom-free survival rate. RESULTS The most frequent presenting symptoms were postprandial abdominal pain (18 patients [75%]) and weight loss (14 patients [58%]). Less specific complaints included nausea and vomiting (8 patients [33%]), diarrhea (7 patients [29%]), and constipation (4 patients [17%]). Atherosclerotic risk factors were common, including tobacco use (20 patients [83%]), coronary artery disease (10 patients [42%]), and hypertension (10 patients [42%]). The cause was identified as atherosclerosis in 21 patients, median arcuate ligament compression in 2 patients who were monozygotic twins, and Takayasu arteritis in 1 patient. Lesions were localized to all 3 major visceral vessels (celiac artery, superior mesenteric artery [SMA], and inferior mesenteric artery) in 8 patients, celiac artery and SMA in 13, SMA alone in 2, and SMA and inferior mesenteric artery in 1. Seventeen patients underwent antegrade reconstructions from the supraceliac aorta to the SMA and/or celiac artery; 7 patients underwent revascularization by use of a retrograde bypass that originated from the infrarenal aorta or a prosthetic graft. There were no perioperative deaths although 1 patient died in the hospital 6 weeks after early graft failure and sepsis (overall in-hospital mortality, 4%). Follow-up ranged from 3 months to 10 years (median, 2.4 years). The mean +/- SEM 5-year primary graft patency rate, as objectively documented by use of contrast angiography or duplex scanning in 19 of 24 patients, was 78% +/- 11%. Primary failure was documented in 3 patients (at 3 weeks, 5 months, and 7 months). Two patients required a thrombectomy; 1 of these patients subsequently died of an intestinal infarction. The mean +/- SEM 5-year survival rate by use of life-table analysis was 71% +/- 11%. No patient with a patent graft experienced a symptomatic recurrence. CONCLUSIONS Chronic mesenteric ischemia is usually a manifestation of advanced systemic atherosclerosis. Symptoms almost always reflect midgut ischemia in the distribution of the SMA. An antegrade bypass from the supraceliac aorta can be performed with acceptable operative morbidity and is currently the preferred reconstructive technique. Surgical revascularization affords long-term symptom-free survival in a majority of patients with chronic mesenteric ischemia.
Diminished postprandial hyperemia in patients with aortic and mesenteric arterial occlusive disease. Quantification by magnetic resonance flow imaging.
主动脉和肠系膜动脉闭塞性疾病患者的餐后充血减少。
DOI： --
发表时间： 1996
期刊： Circulation.
影响因子： --
作者：
Dalman,RL;Li,KC;Moon,WK;Chen,I;Zarins,CK
通讯作者： Zarins,CK