| Objective To investigate the clinical process of acute mesenteric ischemia and to compare the different process of thrombo-embolism of mesenteric artery and thrombosis of mesenteric vein.Particularly,in the hope of improving the prognosis of patients,the prognostic factors of acute mesenteric ischemia were investigated.Methods The clinical record of 99 consecutive patients admitted from June 2008 to November 2016 with acute mesenteric ischemia were retrospectively reviewed.The clinical data of patients with artery and vein ischemia were analyzed respectively.The demographic characteristics,co-morbidity,symptoms,time between symptoms onset and admission,surgical types were compared between survivors and non survivors.The factors which demonstrated significant different between group were also entered into the multivariate analysis.Results Of the patients with acute mesenteric ischemia,there were 44 cases of arterial ischemia and 55 cases of venous thrombus.Most of the patients were confirmed to develop enteric necrosis during the operation.The length of the enteric necrosis ranged from 20 cm to the whole small intestine: in 22 cases,the small intestine was partially necrotic(the necrotic length was shorter than 1m;in 2 cases,there were necrosis of partial colon);in 35 cases,most part of small intestine was necrotic(the necrotic length was from 1m to 2m;in 1 case,there were necrosis of partial colon);in 36 cases,the small intestine was extensively necrotic(the necrotic length was over 2m;in 10 cases,there were necrosis of partial colon).Of the patients with arterial ischemia: 3 cases develop whole small intestinal necrosis and the surgery is abandoned,3 other cases show no evidence of necrosis and no resection was made.The remained 38 cases received necrotic intestine resection.Of the 38 patients,anastomosis was made in 11 patients(28.9%)and the enterostomy was made in 27 patients(71.1%).Of the patients with venous thrombus: all patients were confirmed to have enteric necrosis,32 patients(58.2%)and 23 patients(41.8%)received anastomosis and enterostomy respectively.Patients with arterial ischemia suffered more postoperative complications compares with those with venous thrombus.In patients with arterial ischemia,eighteen patients(40.9%)developed severe complications: seven patients with septic shock(21.1%),five patients with respiratory failure(13.2%),five patients with surgical incision dehiscence(13.2%).The mortality of the arterial ischemia patients is 25%.In patients with venous thrombus,ten patients(18.2%)developed severe complications: five patients with septic shock(9.09%),two patients with respiratory failure(3.64%),two patients with surgical incision dehiscence(3.64%).The mortality of the arterial ischemia patients is 10.9%.Conclusion 1.In patients with acute mesenteric ischemia disease,arterial ischemia demonstrates no gender bias while the venous thrombus affects more males;2.Compares with arterial ischemia,venous thrombus have a longer course of disease.CT angiography remains the most accurate diagnostic method for acute mesenteric ischemia.Though the current laboratory index have no diagnostic value in the diagnosis,it has some guide meaning in the severity evaluation;3.In patients with arterial ischemia,older age,hypotension,Fullen level,length of necrotic intestine and the anastomosis indicate a poor prognosis.As for patients with venous thrombus,only the longer length of necrotic intestine indicate a worse prognosis.4.Timely operation is the crucial treatment for acute mesenteric ischemia.Compared with the anastomosis,enterostomy is accompanied with decreased mortality and should be considered as the standard surgical type for patients with acute mesenteric ischemia. |
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