Diagnosis And Treatment For 16 Cases Of Acute Mesenteric Ischemia

Objective:To investigate the clinical diagnosis and treatment of acute mesenteric ischemia by analyzing their clinical features. Methods:Collection of all clinical data of 16 patients who diagnosed AMI by CT, DSA or surgery in the Department of Vascular Surgery of the First Affiliated Hospital of Fujian Medical University from Jan 2015 to Dec 2015. To analyze their history, examination, diagnosis, treatment and prognosis by dividing into necrosis and nonnecrosis. Results: 1?The age of onset of AMI patients is from 38 years old to 84 years old, mean age is(52.88±14.46)years, the ratio of male and female is 7:1. There is no significant difference between two groups on ages. 2?The course of AMI patients is from12 hours to1 year, the median is 4.0(1.63-17.5)days. There is no significant difference between two groups on course. 3?The hospitalization time of AMI patients is from 5 days to 90 days, the median is 15.5(8.5-26.5)days. There is no significant difference between two groups on hospitalization time. 4?All patients had manifestation of abdominal pain, 37.5%(6/16) cases had manifestation of bloating, 37.5%(6/16) cases had manifestation of blood stool, 31.25%(5/16) cases had manifestation of nausea and vomiting, and 56.25%(9/16) cases had emerged with signs of peritonitis stimulation. 5?The ratio of elevated white blood cell was 43.75%(7/16) and neutrophils ratio was 56.25%(9/16),respectively.The mean of WBC and neutrophils ratio of necrosis group is(15.39±5.27)×109 and(91.35±2.33)%, respectively. The other group is(8.30±4.69)×109 and(70.01±15.07)%, respectively. The mean of WBC and neutrophils ratio of necrosis group is higher than nonnecrotic group significantly.6?The appearance ratio of D-dimmer masculine was 100%(9/9), CRP was 53.84%(7/13)and creatine kinase was 25%(3/12), respectively. 7?The most important imageological diagnosis of AMI is CT and its accuracy rate is 100%. The main direct manifestation of CT is filling defect. The indirect manifestation of CT includes bowel wall thickening, bowel dilatation, intestinal wall density change, hydroperitoneum and mesenteric change. 8?The treatment included drug therapy and operation. The operation include interventional operation and surgery operation. The necrosis group choose surgery operation and its improvement rate is 100%. The nonnecrotic group choose drug therapy and interventional operation, and its improvement rate is 100% and 83.33%,,respectively. Conclusions: 1. When the patients are persistent abdominal pain which we can not explain, we should choose CT and DSA examinations in time for higher diagnostic ratio. 2. It is critical to have exploratory laparotomy in time for confirmed necrotic bowel for reducing the mortality and complication. 3. Endoscopic technology gradually become main treatment for AMI. 4. AMI need conservative treatment and surgical treatment.