نتايج درمان جراحي 32 مورد ايسكمي مزانتريك در بيمارستان شهداء تجريش

Outcome of Surgical Therapy in 32 Cases with Mesenteric Ischemia in Shohadaye Tajrish Hospital

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺍﻳﺴﻜﻤـﻲ ﺣﺎﺩ ﻣـﺰﺍﻧﺘﺮ، ﻳﻜﻲ ﺍﺯ ﺩﻻﺋﻞ ﺷﻜـﻢ ﺣـﺎﺩ ﺍﺳﺖ ﻛﻪ ﺑﻪ ﻋﻠـﺖ ﻛﺎﻫﺶ ﭼﺸﻤﮕﻴـﺮ ﺩﺭ ﭘﺮﻓﻴـﻮﮊﻥ ﺭﻭﺩﻩ ﺭﻭﻱ ﻣﻲ ﺩﻫﺪ. ﻣـﺮﮒ ﻭ ﻣﻴﺮ 60- 100 ﺩﺭﺻﺪ ﺩﺭ ﻣﻄﺎﻟﻌـﺎﺕ ﮔﻮﻧﺎﮔﻮﻥ ﺑﺮﺍﻱ ﺍﻳﻦ ﺑﻴﻤـﺎﺭﻱ ﻛﺸﻨﺪﻩ ﮔﺰﺍﺭﺵ ﺷﺪﻩ ﺍﺳﺖ. ﻫﺪﻑ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺮﺭﺳﻲ ﺭﺍﻩ ﻫﺎﻱ ﻛﺎﻫﺶ ﻋﻮﺍﺭﺽ ﻭ ﻣﺮﮒ ﻭ ﻣﻴﺮ ﻣﻲ ﺑﺎﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﮔﺬﺷﺘﻪ ﻧﮕﺮ، ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎ ﺗﺸﺨﻴﺺ ﻧﻬﺎﻳﻲ ﺍﻳﺴﻜﻤﻲ ﺣﺎﺩ ﻣﺰﺍﻧﺘﺮ ﭘﺬﻳﺮﺵ ﺷﺪﻩ ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺷﻬﺪﺍﺀ ﺗﺠﺮﻳﺶ، ﺑﺮﺍﺳﺎﺱ ﺑﺮﺭﺳﻲ ﭘﺮﻭﻧﺪﻩ ﻫﺎﻱ ﭘﺰﺷﻜﻲ ﺷﺮﻛﺖ ﻧﻤﻮﺩﻧﺪ. ﺩﺭ ﺍﻳﻦ ﭘﮋﻭﻫﺶ ﻣﺸﺨﺼﺎﺕ ﺑﺎﻟﻴﻨـﻲ، ﻳﺎﻓﺘﻪ ﻫﺎﻱ ﺁﺯﻣﺎﻳﺸﮕﺎﻫﻲ، ﮔـﺮﺍﻓﻲ ﻫﺎﻱ ﺷﻜـﻢ، ECGﻫﺎ، ﻳﺎﻓﺘﻪ ﻫﺎﻱ ﺣﻴﻦ ﻋﻤﻞ ﻭ ﻧﺘﺎﻳﺞ ﺩﺭﻣﺎﻥ ﺩﺭ 32 ﺑﻴﻤﺎﺭ ﭘﺬﻳﺮﺵ ﺷﺪﻩ ﺍﺯ ﺑﻬﻤﻦ 1375 ﺗﺎ ﺑﻬﻤﻦ 1381 ﻣﺮﻭﺭ ﮔﺮﺩﻳﺪﻩ ﺍﺳﺖ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺑﻴﻤﺎﺭﻱ ﺩﺭ ﻣﺮﺩﺍﻥ 2 ﺑﺮﺍﺑﺮ ﻧﺴﺒﺖ ﺑﻪ ﺯﻧﺎﻥ ﺷﺎﻳﻌﺘﺮ ﺑﻮﺩ. ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ ﺑﻴﻤﺎﺭﺍﻥ 60 ﺳﺎﻝ ﺑﻮﺩ. ﺩﺭﺩ ﺷﻜﻤﻲ ﺷﺎﻳﻌﺘﺮﻳﻦ ﻋﻼﻣﺖ ﺑﻴﻤﺎﺭﺍﻥ ﺑﻮﺩ ﻭ ﺑﻌﺪ ﺍﺯ ﺁﻥ ﺗﻬﻮﻉ، ﺍﺳﺘﻔﺮﺍﻍ، ﻋﺪﻡ ﺩﻓﻊ ﮔﺎﺯ ﻭ ﻣﺪﻓﻮﻉ، ﻫﻤﺎﺗﻤﺰ ﻭ ﻣﻠﻨﺎ ﻭ ﺩﺭ ﻣﻌﺎﻳﻨﺔ ﻓﻴﺰﻳﻜﻲ، ﺗﺎﻛﻴﻜﺎﺭﺩﻱ ﺷﺎﻳﻊ ﺑﻮﺩ. ﺍﻟﻴﮕﻮﺭﻱ ﺗﻘﺮﻳﺒﺎﹰ ﺩﺭ 70 ﺑﻴﻤﺎﺭﺍﻥ ﻣﺸﺎﻫﺪﻩ ﮔﺮﺩﻳﺪ ﻭ ﺑﺎ ﻣﺮﮒ ﻭ ﻣﻴﺮ ﺑﻴﻤﺎﺭﺍﻥ ﺭﺍﺑﻄﻪ ﺩﺍﺷﺖ. ﺣﺪﻭﺩ 10 ﺑﻴﻤﺎﺭﺍﻥ ﺩﺭ ﺣﺎﻟﺖ ﺷﻮﻙ ﺑﻮﺩﻧﺪ ﻛﻪ ﺩﺭ ﺭﺍﺑﻄﻪ ﺑﺎ ﻣﺮﮒ ﻭ ﻣﻴﺮ ﺑﻴﻤﺎﺭﺍﻥ ﺑﻮﺩ. ﻣﻴﺰﺍﻥ 30 ﺑﻴﻤﺎﺭﺍﻥ ﻋﻼﻳﻢ ﭘﺮﻳﺘﻮﻧﺌﺎﻝ ﺩﺍﺷﺘﻨﺪ ﻭﻟﻲ ﻣﺮﺗﺒﻂ ﺑﺎ ﻣﺮﮒ ﻭ ﻣﻴﺮ ﺑﻴﻤﺎﺭﺍﻥ ﻧﺒﻮﺩ. ﺩﺭ ﺑﺮﺭﺳﻲ ﻫﺎﻱ ﺁﺯﻣﺎﻳﺸﮕﺎﻫﻲ ﻟﻜﻮﺳﻴﺘﻮﺯ ﺩﺭ 95 ﺑﻴﻤﺎﺭﺍﻥ ﻭﺟﻮﺩ ﺩﺍﺷﺖ ﻭ ﺩﺭ 50 ﻣﻮﺍﺭﺩ ﺑﻴﺶ ﺍﺯ 20.000 ﺩﺭ ﻣﻴﻠﻴﻤﺘﺮ ﻣﻜﻌﺐ ﺑﻮﺩ. ﺍﺳﻴﺪﻭﺯ ﺩﺭ 80% ﺑﻴﻤﺎﺭﺍﻥ ﻭﺟﻮﺩ ﺩﺍﺷﺖ ﻭ ﻣﻴﺰﺍﻥ ﻛﻞ ﻣﺮﮒ ﻭ ﻣﻴﺮ 75 ﺑﻮﺩ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺗﻮﺻﻴﻪ ﻧﻬـﺎﻳﻲ ﻣﻄﺎﻟﻌﻪ، ﺗﻮﺟـﻪ ﺷﺪﻳﺪ ﺑﻪ ﺍﺣﻴـﺎﺀ ﺑﻴﻤﺎﺭﺍﻥ، ﺗﺼﺤﻴـﺢ ﺍﺧﺘﻼﻻﺕ ﻣﺘﺎﺑﻮﻟﻴـﻚ ﻭ ﻫﻤـﻮﺩﻳﻨﺎﻣﻴﻚ ﻭ ﺍﻧﺠـﺎﻡ ﻻﭘﺎﺭﺍﺗﻮﻣﻲ ﻓـﻮﺭﻱ ﺑﻌـﺪ ﺍﺯ ﺗﺼﺤﻴﺢ ﺍﻳﻦ ﺍﺧﺘﻼﻻﺕ ﻣﻲ ﺑﺎﺷـﺪ. ﺩﺭ ﺑﺮﺧـﻲ ﺑﻴﻤﺎﺭﺍﻥ ﻧﻴﺎﺯ ﺑﻪ ﺍﻧﺠـﺎﻡ ﻋﻤـﻞ ﺩﻭﻡ ﺑﺮﺍﻱ ﺍﺭﺯﻳﺎﺑﻲ ﺯﻧﺪﻩ ﺑﻮﺩﻥ ﺭﻭﺩﻩ ﻣﻲ ﺑﺎﺷﺪ.

Introduction & Objective: Acute mesenteric ischemia, an important cause of acute abdomen, develops due to a dramatic decrease in intestinal blood supply. According to different series, mortality rate ranges from 60 to 100 percent. This study reviews the clinical features, laboratory data, abdominal radiographs, preoperative ECG, intraoperative findings and treatment results in 32 patients admitted with a diagnosis of acute mesenteric ischemia, from March 1996 to March 2002 to Shohadae Tajrish medical center, Tehran, Iran. Materials & Methods: In a retrospective study we reviewed 32 patients admitted with a diagnosis of acute mesenteric ischemia at Shohadae Tajrish Medical Center, according to the data in their medical records. Results: The disease was twice as common in males as in females, with a mean age of 60 years at the time of presentation. Abdominal pain was the most common symptom followed by nausea, vomiting, obstipation, hematemesis and melena in decreasing order of frequency. On physical examination, most patients had tachycardia. Oliguria was present in 70% of patients and correlated with mortality rate. Shock was also encountered in 10% of cases with a close correlation with mortality. In 30% of patients, peritoneal signs were present which didn’t correlate with mortality. As laboratory findings, leukocytosis was encountered in 95 % of patients which exceeded 20000 / mm3 in 50 % of patients. Eighty percent of patients had acidosis. Overall mortality was estimated to be 75%. Conclusions: According to this study early attention to patient resuscitation, correction of metabolic and homodynamic abnormalities and expeditious surgery are essential steps for successful management of mesenteric ischemia. In selected cases a second look operation is warranted to re-evaluate the viability of the bowel.