- 作者：Olivier Corcos? ; olivier.corcos@bjn.aphp.fr ; Yves Castier&Dagger ; ; Annie Sibert§ ; ; Sebastien Gaujoux¡Î ; Maxime Ronot§ ; ; Francisca Joly? ; Catherine Paugam¶ ; ; Frederic Bretagnol# ; Mohamed Abdel&ndash ; Rehim§ ; ; Fadi Francis&Dagger ; ; Vanessa Bondjemah? ; Marianne Ferron# ; Magaly Zappa§ ; ; Aurelien Amiot? ; Carmen Stefanescu? ; Guy Leseche&Dagger ; ; Jean&ndash ; Pierre Marmuse?? ; Jacques Belghiti¡Î ; Philippe Ruszniewski&Dagger ; &Dagger ; ; Valerie Vilgrain§ ; ; Yves Panis# ; Jean Mantz¶ ; ; Yoram Bouhnik?
- 关键词：Intestinal Stroke ; Short-Bowel Syndrome ; Parenteral Nutrition ; Superior Mesentery Artery
- 刊名：Clinical Gastroenterology and Hepatology
- 出版年：2013
- 出版时间：February, 2013
- 年：2013
- 卷：11
- 期：2
- 页码：158-165.e2
- 全文大小：1891 K
Background & Aims
Acute mesenteric ischemia (AMI) is an emergency with a high mortality rate; survivors have high rates of intestinal failure. We performed a prospective study to assess a multidisciplinary and multimodal management approach, focused on intestinal viability.Methods
In an Intestinal Stroke Center, we developed a multimodal management strategy involving gastroenterologists, vascular and abdominal surgeons, radiologists, and intensive care specialists; it was tested in a pilot study on 18 consecutive patients with occlusive AMI, admitted to a tertiary center from July 2009 to November 2011. Patients with left ischemic colitis, nonocclusive AMI, chronic mesenteric ischemia, and other emergencies were excluded. Patients received specific medical management: revascularization of viable small bowel and/or resection of nonviable small bowel; 12 patients received arterial revascularization. We evaluated the percentages of patients who survived for 30 days or 2 years, the number with permanent intestinal failure, and morbidity. Lengths and rates of intestinal resection were compared with or without revascularization, and in patients with early or late-stage disease.
Results
Patients were followed up for a mean of 497 days (range, 7-2085 d); 95 % survived for 30 days, 89 % survived for 2 years, and 28 % had morbidities within 30 days. Intestinal resection was necessary for 7 cases (39 % ), with mean lengths of intestinal resection of 30 cm and 207 cm, with or without revascularization, respectively (P = .03). Among patients with early or late-stage AMI, rates of resection were 18 % and 71 % , respectively (P = .049). Patients with early stage disease had shorter lengths of intestinal resection than those with late-stage disease (7 vs 94 cm; P = .02), and spent less time in intensive care (2.5 vs 49.8; P = .02).
Conclusions
A multidisciplinary and multimodal management approach might increase survival of patients with AMI and prevent intestinal failure.