[Surgical therapy of acute mesenteric ischemia].
Between 1972 and 1993 a total of 90 patients were operated on for acute mesenteric ischemia at Hanover Medical School, Department of Abdominal- and Transplantation Surgery. As causes of mesenteric ischemia, arterial embolism (23%), arterial thrombosis (30%), venous thrombosis (33%), and non-occlusive disease (14%) were differentiated. The overall hospital mortality was 66%. The hospital mortality after venous thrombosis was 37%, significantly lower than after arterial (79%) and functional (83%) types of mesenteric ischemia. Besides the pathogenesis of mesenteric infarction, a multivariate analysis revealed age and presence of peritonitis and intestinal perforation to be independent prognostic factors of hospital lethality. Patients with venous thrombosis had a mean age of 48 years and were significantly younger than the remaining patients who had an average age of over 60 years. Surgical procedures comprised solitary bowel resection (60%), isolated embolectomy and/or thrombectomy (10%), a combination of embolectomy/thrombectomy and bowel resection (4%), and exploratory laparotomy only (21%). Vascular reconstruction was associated with a significantly better survival rate than bowel resection only. While hospital mortality was dependent on the type of mesenteric ischemia, long-term survival after exclusion of hospital deaths proved independent of the original pathogenesis. Of the patients who survived the acute attack of mesenteric ischemia, 70% were alive 2 years later and 50% 5 years later. The survival probability of these patients was not determined by recurrence of mesenteric ischemia, but was mainly related to their cardiovascular comorbidity and a high incidence and prevalence of malignancies.
Grothues
F
F
Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover.
Bektas
H
H
Klempnauer
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D017128:Embolectomy; D004617:Embolism / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007422:Intestines / Q000098:blood supply*; D007511:Ischemia / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008638:Mesenteric Arteries / Q000601:surgery; D008641:Mesenteric Vascular Occlusion / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008642:Mesenteric Veins / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate; D017131:Thrombectomy; D013927:Thrombosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*
Chirurgische Therapie akuter mesenterialer Ischämien.