PDF(Pubmed)
Abstract：
Chronic mesenteric ischemia (CMI) is a vascular disorder primarily caused by atherosclerosis, resulting in intestinal ischemia. While endovascular treatment has become the primary modality for most patients, open mesenteric revascularization remains crucial for complex cases. We present a case of CMI in a patient with critical ischemia, leading to small bowel necrosis, where the endovascular recanalization failed and a surgical approach was needed. A supraceliac antegrade aortomesenteric bypass was performed, and successful revascularization of intestinal circulation was achieved. A novel prefabricated bovine pericardium tube was used as a graft, and the bypass was placed behind the pancreas to ensure maximal isolation from the contaminated abdominal cavity. Despite the intestinal revascularization, in the early postoperative period, the overall condition of the patient worsened with obvious signs of peritonitis. The second look operation revealed a ruptured gallbladder with severe biliary peritonitis, likely caused by the preceding splanchnic ischemia. A cholecystectomy, lavage, and drainage were performed. No further intestinal necrosis was observed, and the bowel passage was restored with latero-lateral jejuno-lejunostomy. The follow-up of the patient showed no signs of graft infection. Despite the complications, the patient\'s postoperative period was stable, and he was discharged on day sixteen. Regular follow-ups confirmed an excellent patency of the bypass.
摘要：
慢性肠系膜缺血（CMI）是一种主要由动脉粥样硬化引起的血管疾病，导致肠缺血。虽然血管内治疗已成为大多数患者的主要治疗方式，开放式肠系膜血运重建对于复杂病例仍然至关重要。我们介绍了一例严重缺血患者的CMI，导致小肠坏死,血管内再通失败，需要手术入路。进行了腹腔顺行主动脉-肠外搭桥,并成功实现肠循环血运重建。一种新型的预制牛心包管被用作移植物，旁路放置在胰腺后面，以确保与受污染的腹腔最大程度地隔离。尽管有肠道血运重建,在术后早期，患者的整体状况恶化，并伴有明显的腹膜炎征象。第二眼手术显示胆囊破裂伴有严重的胆汁性腹膜炎，可能是由之前的内脏缺血引起的。胆囊切除术,灌洗,并进行了引流。没有观察到进一步的肠坏死，通过空肠外侧-空肠-空肠吻合术恢复肠道。患者的随访显示没有移植物感染的迹象。尽管有并发症,患者的术后时间稳定，他在第16天出院了.定期随访证实了旁路的良好通畅性。
