评估急性肠系膜缺血病例中的损伤控制手术,以挽救小肠长度

Ahmed M. Hanafy, Mohamed A. Nada, Essam F. Ebied, K. Kamel
{"title":"评估急性肠系膜缺血病例中的损伤控制手术,以挽救小肠长度","authors":"Ahmed M. Hanafy, Mohamed A. Nada, Essam F. Ebied, K. Kamel","doi":"10.21608/ejsur.2024.357113","DOIUrl":null,"url":null,"abstract":"Background: In the context of acute mesenteric ischemia (AMI), the extent of bowel resection poses a surgical complexity due to the potential exacerbation of mesenteric ischemia postsurgery. Consequently, employing damage-control surgery (DCS) alongside a subsequent second-look operation presents an opportunity to effectively address the critical state of the patient and evaluate bowel viability after resuscitative measures. Objectives: Evaluate the role of DCS in salvaging small bowel segments that were doubtful during the primary operation after resection of the necrotic bowel. Assess the role of DCS in overall morbidity and mortality. Patients and Methods: A prospective cohort study conducted at Ain-Shams University Hospitals. A total of 29 patients were admitted to our department with the diagnosis of AMI and underwent DCS. Twenty-two patients were hemodynamically unstable intraoperatively, and seven patients were stable. They were evaluated regarding saving bowel length from resection and overall morbidity and mortality. Results: A total of 29 patients underwent DCS for diffuse mesenteric ischemia with ill-defined margins for gangrenous bowel; all patients passed without stump blowout, and further resection of previously query ischemic segments done in 22 (75.9%) patients, saving bowel length from resection reaching up to 18 cm. Three (10.3%) patients had anastomotic leakage that has been managed conservatively; one of them had an enterocutaneous fistula that resolved over 6 weeks. Conclusion: The DCS strategy (abbreviated laparotomy) offers significant advantages and demonstrates commendable outcomes among patients with AMI with diffuse and indistinct margins. This approach notably contributes to preserving bowel length and reducing the overall morbidity and mortality rates","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"292 5","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Evaluation of damage-control surgery in cases of acute mesenteric ischemia for salvaging small bowel length\",\"authors\":\"Ahmed M. Hanafy, Mohamed A. Nada, Essam F. Ebied, K. Kamel\",\"doi\":\"10.21608/ejsur.2024.357113\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: In the context of acute mesenteric ischemia (AMI), the extent of bowel resection poses a surgical complexity due to the potential exacerbation of mesenteric ischemia postsurgery. Consequently, employing damage-control surgery (DCS) alongside a subsequent second-look operation presents an opportunity to effectively address the critical state of the patient and evaluate bowel viability after resuscitative measures. Objectives: Evaluate the role of DCS in salvaging small bowel segments that were doubtful during the primary operation after resection of the necrotic bowel. Assess the role of DCS in overall morbidity and mortality. Patients and Methods: A prospective cohort study conducted at Ain-Shams University Hospitals. A total of 29 patients were admitted to our department with the diagnosis of AMI and underwent DCS. Twenty-two patients were hemodynamically unstable intraoperatively, and seven patients were stable. They were evaluated regarding saving bowel length from resection and overall morbidity and mortality. Results: A total of 29 patients underwent DCS for diffuse mesenteric ischemia with ill-defined margins for gangrenous bowel; all patients passed without stump blowout, and further resection of previously query ischemic segments done in 22 (75.9%) patients, saving bowel length from resection reaching up to 18 cm. Three (10.3%) patients had anastomotic leakage that has been managed conservatively; one of them had an enterocutaneous fistula that resolved over 6 weeks. Conclusion: The DCS strategy (abbreviated laparotomy) offers significant advantages and demonstrates commendable outcomes among patients with AMI with diffuse and indistinct margins. This approach notably contributes to preserving bowel length and reducing the overall morbidity and mortality rates\",\"PeriodicalId\":22550,\"journal\":{\"name\":\"The Egyptian Journal of Surgery\",\"volume\":\"292 5\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The Egyptian Journal of Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.21608/ejsur.2024.357113\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Egyptian Journal of Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.21608/ejsur.2024.357113","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

背景:在急性肠系膜缺血(AMI)的情况下,由于术后肠系膜缺血有可能加重,因此肠切除的范围给手术带来了复杂性。因此,在采用损伤控制手术(DCS)的同时进行后续的二视手术是有效处理患者危急状态和评估复苏措施后肠道存活能力的一个机会。目标:评估损伤控制手术在切除坏死肠道后挽救初次手术中存疑的小肠段方面的作用。评估 DCS 在总体发病率和死亡率中的作用。患者和方法:艾因-沙姆斯大学医院开展的一项前瞻性队列研究。共有 29 名患者被诊断为急性心肌梗死并在我院住院,接受了 DCS 治疗。22 名患者术中血流动力学不稳定,7 名患者血流动力学稳定。我们对这些患者的切除肠道保存长度、总体发病率和死亡率进行了评估。结果:共有29名患者因肠系膜弥漫性缺血且坏疽肠管边缘不清而接受了肠系膜腔内介入手术;所有患者均顺利通过手术,未出现残端出血,22名患者(75.9%)进一步切除了之前询问过的缺血肠段,切除肠段所保留的肠管长度达18厘米。3名患者(10.3%)出现吻合口漏,已采取保守治疗;其中一名患者出现肠瘘,6周后愈合。最后得出结论:DCS 策略(简略开腹手术)在边缘弥漫不清的急性肠梗阻患者中具有显著优势和值得称赞的疗效。这种方法明显有助于保留肠道长度,降低总体发病率和死亡率
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Evaluation of damage-control surgery in cases of acute mesenteric ischemia for salvaging small bowel length
Background: In the context of acute mesenteric ischemia (AMI), the extent of bowel resection poses a surgical complexity due to the potential exacerbation of mesenteric ischemia postsurgery. Consequently, employing damage-control surgery (DCS) alongside a subsequent second-look operation presents an opportunity to effectively address the critical state of the patient and evaluate bowel viability after resuscitative measures. Objectives: Evaluate the role of DCS in salvaging small bowel segments that were doubtful during the primary operation after resection of the necrotic bowel. Assess the role of DCS in overall morbidity and mortality. Patients and Methods: A prospective cohort study conducted at Ain-Shams University Hospitals. A total of 29 patients were admitted to our department with the diagnosis of AMI and underwent DCS. Twenty-two patients were hemodynamically unstable intraoperatively, and seven patients were stable. They were evaluated regarding saving bowel length from resection and overall morbidity and mortality. Results: A total of 29 patients underwent DCS for diffuse mesenteric ischemia with ill-defined margins for gangrenous bowel; all patients passed without stump blowout, and further resection of previously query ischemic segments done in 22 (75.9%) patients, saving bowel length from resection reaching up to 18 cm. Three (10.3%) patients had anastomotic leakage that has been managed conservatively; one of them had an enterocutaneous fistula that resolved over 6 weeks. Conclusion: The DCS strategy (abbreviated laparotomy) offers significant advantages and demonstrates commendable outcomes among patients with AMI with diffuse and indistinct margins. This approach notably contributes to preserving bowel length and reducing the overall morbidity and mortality rates
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
Study of the value of core biopsy for establishing tissue diagnosis compared to excisional biopsy in enlarged cervical lymph nodes Fibrin glue versus sutures for mesh fixation in open repair of inguinal hernia Doppler-guided hemorrhoidal artery ligation with mucopexy versus stapled hemorrhoidopexy in the management of grades 3 and 4 prolapsed hemorrhoids: A prospective randomized clinical study Solitary fibrous tumor of the pleura Correlating preoperative clinicopathological factors with skin and/ or nipple–areola complex tumor involvement in postmastectomy specimens
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1