Advances in the diagnosis and treatment of mesenteric ischemia under the multidisciplinary diagnosis and treatment model_West China Medical Journal

Authors：

LI Liujiang ^1,2 , YANG Jinjiang ^1,2 ,  LI Guojian ^1,2 , WAN Jia ² , WU Ruoyong ^1,2 ,  YANG Yong ^1,2

1. Department of Vascular Surgery, the Fourth Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650021, P. R. China;
2. Vascular Surgery Center of Yunnan Province, Kunming, Yunnan 650021, P. R. China;

Corresponding author：

YANG Yong, Email: 378096090@qq.com

Keywords：

Mesenteric ischemia; epidemiology; clinical staging; intestinal infarction; multidisciplinary diagnosis and treatment

DOI：

10.7507/1002-0179.202011006

Video：

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The misdiagnosis rate and mortality of mesenteric ischemia are high, but with the continuous updating of diagnosis and treatment techniques and treatment concepts in recent years, many patients can get timely and effective treatment. This article starts from the epidemiology, vascular anatomy, etiology, clinical manifestations and classification of mesenteric ischemia, and the progress of diagnosis and treatment under the multidisciplinary diagnosis and treatment mode, and details the research progress of mesenteric ischemia at home and abroad. This paper focuses on the significance of multidisciplinary diagnosis and treatment mode in the diagnosis and treatment of mesenteric ischemia, in order to strengthen the treatment consciousness of mesenteric ischemia and explore a more accurate and effective treatment system. The purpose of this study is to provide some reference for avoiding intestinal infarction and improving the survival rate of intestinal tract.

Citation： LI Liujiang, YANG Jinjiang, LI Guojian, WAN Jia, WU Ruoyong, YANG Yong. Advances in the diagnosis and treatment of mesenteric ischemia under the multidisciplinary diagnosis and treatment model. West China Medical Journal, 2022, 37(2): 313-317. doi: 10.7507/1002-0179.202011006 Copy

1.	Clair DG, Beach JM. Mesenteric Ischemia. N Engl J Med, 2016, 374(10): 959-968.
2.	Nuzzo A, Huguet A, Corcos O. Modern treatment of mesenteric ischemia. Presse Med, 2018, 47(6): 519-530.
3.	Corcos O, Castier Y, Sibert A, et al. Effects of a multimodal management strategy for acute mesenteric ischemia on survival and intestinal failure. Clin Gastroenterol Hepatol, 2013, 11(2): 158-165.e2.
4.	朱明杰, 王自强. 应重视培养急腹症诊断中急性肠缺血的病理生理与 CT 影像相关联的系统性思维模式. 中国普外基础与临床杂志, 2020, 27(12): 1473-1479.
5.	Zettervall SL, Lo RC, Soden PA, et al. Trends in treatment and mortality for mesenteric ischemia in the United States from 2000 to 2012. Ann Vasc Surg, 2017, 42: 111-119.
6.	Tilsed JV, Casamassima A, Kurihara H, et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg, 2016, 42(2): 253-270.
7.	Kumar S, Sarr MG, Kamath PS. Mesenteric venous thrombosis. N Engl J Med, 2001, 345(23): 1683-1688.
8.	鞠乐乐, 颜玉, 周玲玲. 老年人缺血性肠病的临床特点及诊断分析进展. 微量元素与健康研究, 2020, 37(2): 70-72.
9.	肖毅, 陆君阳, 徐徕, 等. 肠系膜上血管系统解剖特点的临床研究. 中华外科杂志, 2019, 57(9): 673-680.
10.	施德兵, 符伟国. 肠系膜缺血性疾病的临床病理生理. 中国实用外科杂志, 2006(6): 405-407.
11.	林继平, 肖亦明, 唐承富, 等. 不同支架应用方式对肠系膜上动脉夹层动脉瘤患者的作用及预后对比分析. 心肺血管病杂志, 2020, 39(4): 436-439, 444.
12.	Al-Diery H, Phillips A, Evennett N, et al. The pathogenesis of nonocclusive mesenteric ischemia: implications for research and clinical practice. J Intensive Care Med, 2019, 34(10): 771-781.
13.	Mastoraki A, Mastoraki S, Tziava E, et al. Mesenteric ischemia: pathogenesis and challenging diagnostic and therapeutic modalities. World J Gastrointest Pathophysiol, 2016, 7(1): 125-130.
14.	Bergan JJ, Dean RH, Conn J Jr, et al. Revascularization in treatment of mesenteric infarction. Ann Surg, 1975, 182(4): 430-438.
15.	龙禛朴, 余阳华, 陈霄霄, 等. 缺血性结肠炎临床特征分析: 附 101 报告. 中国普通外科杂志, 2020, 29(8): 979-986.
16.	张玮, 陈熹阳. 急慢性肠系膜缺血的诊治. 中华血管外科杂志, 2021, 6(3): 147-151.
17.	Brandt LJ, Feuerstadt P, Longstreth GF, et al. ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI). Am J Gastroenterol, 2015, 110(1): 18-44.
18.	Ten Heggeler LB, van Dam LJ, Bijlsma A, et al. Colon ischemia: right-sided colon involvement has a different presentation, etiology and worse outcome. A large retrospective cohort study in histology proven patients. Best Pract Res Clin Gastroenterol, 2017, 31(1): 111-117.
19.	Yun WS, Kim YW, Park KB, et al. Clinical and angiographic follow-up of spontaneous isolated superior mesenteric artery dissection. Eur J Vasc Endovasc Surg, 2009, 37(5): 572-577.
20.	Yoo J, Lee JB, Park HJ, et al. Classification of spontaneous isolated superior mesenteric artery dissection: correlation with multi-detector CT features and clinical presentation. Abdom Radiol (NY), 2018, 43(11): 3157-3165.
21.	付婷婷, 王炳元. 缺血性肠病研究进展. 中国临床医生, 2016, 44(12): 12-16.
22.	Brandt LJ, Boley SJ. AGA technical review on intestinal ischemia. American Gastrointestinal Association. Gastroenterology, 2000, 118(5): 954-968.
23.	Nuzzo A, Maggiori L, Ronot M, et al. Predictive factors of intestinal necrosis in acute mesenteric ischemia: prospective study from an intestinal stroke center. Am J Gastroenterol, 2017, 112(4): 597-605.
24.	宋弢, 沈平, 王西墨. 急性肠系膜血管缺血性疾病诊断的 Meta 分析. 中国中西医结合外科杂志, 2016, 22(3): 219-223.
25.	Roussel A, Castier Y, Nuzzo A, et al. Revascularization of acute mesenteric ischemia after creation of a dedicated multidisciplinary center. J Vasc Surg, 2015, 62(5): 1251-1256.
26.	胡东来. D-二聚体联合肠脂肪酸结合蛋白早期诊断小儿绞窄性肠梗阻临床研究. 杭州: 浙江大学, 2017.
27.	张福先. 急性肠系膜缺血性疾病诊治现代策略. 中国实用外科杂志, 2020, 40(12): 1373-1375.
28.	孔祥凯, 张震. 超声诊断肠系膜上动脉血栓栓塞疾病的研究进展//中国超声医学工程学会第十届全国超声治疗及生物效应医学学术大会. 中国超声医学工程学会第十届全国超声治疗及生物效应医学学术大会论文汇编. 北京: 中国超声医学工程学会第十届全国超声治疗及生物效应医学学术大会, 2019: 41.
29.	Expert Panel on Vascular Imaging, Reis SP, Majdalany BS, et al. ACR Appropriateness Criteria^® pulsatile abdominal mass suspected abdominal aortic aneurysm. J Am Coll Radiol, 2017, 14(5S): S258-S265.
30.	van Noord D, Sana A, Moons LM, et al. Combining radiological imaging and gastrointestinal tonometry: a minimal invasive and useful approach for the workup of chronic gastrointestinal ischemia. Eur J Gastroenterol Hepatol, 2013, 25(6): 719-725.
31.	Mehdorn M, Köhler H, Rabe SM, et al. Hyperspectral Imaging (HSI) in acute mesenteric ischemia to detect intestinal perfusion deficits. J Surg Res, 2020, 254: 7-15.
32.	Emile SH. Predictive factors for intestinal transmural necrosis in patients with acute mesenteric ischemia. World J Surg, 2018, 42(8): 2364-2372.
33.	Wu JM, Tsai MS, Lin MT, et al. High APACHE Ⅱ score and long length of bowel resection impair the outcomes in patients with necrotic bowel induced hepatic portal venous gas. BMC Gastroenterol, 2011, 11: 18.
34.	Yang S, Fan X, Ding W, et al. Multidisciplinary stepwise management strategy for acute superior mesenteric venous thrombosis: an intestinal stroke center experience. Thromb Res, 2015, 135(1): 36-45.
35.	Parry AH, Wani AH, Yaseen M. Acute mesenteric ischemia in severe coronavirus-19 (COVID-19): possible mechanisms and diagnostic pathway. Acad Radiol, 2020, 27(8): 1190.
36.	朱佩君, 薛静. 系统性红斑狼疮合并缺血性结肠炎 1 例. 中国实用内科杂志, 2020, 40(9): 786-788.
37.	王春喜, 李胜君, 魏志成, 等. 急性肠系膜上动脉栓塞患者血清甲状腺激素及 TSH 水平的观察. 放射免疫学杂志, 2013, 26(3): 258-261.
38.	Nuzzo A, Corcos O. Management of mesenteric ischemia in the era of intestinal stroke centers: the gut and lifesaving strategy. Rev Med Interne, 2017, 38(9): 592-602.
39.	Nuzzo A, Maggiori L, Paugam-Burtz C, et al. Enteral antibiotherapy reduces rates of intestinal resection in acute mesenteric ischemia. Gastroenterology, 2016, 150(4): S691.
40.	朱明洋, 郑翼德. 急性肠系膜上动脉栓塞诊断与治疗的进展. 中国血管外科杂志(电子版), 2020, 12(1): 77-80.
41.	Yang S, Guo J, Ni Q, et al. Enteral nutrition improves clinical outcome and reduces costs of acute mesenteric ischaemia after recanalisation in the intensive care unit. Clin Nutr, 2019, 38(1): 398-406.
42.	Orr NT, Endean ED. Part two: against the motion. an endovascular first strategy is not the optimal approach for treating acute mesenteric ischemia. Eur J Vasc Endovasc Surg, 2015, 50(3): 276-279.
43.	Björck M, Koelemay M, Acosta S, et al. Editor’s choice - management of the diseases of mesenteric arteries and veins: clinical practice guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg, 2017, 53(4): 460-510.
44.	Jansen JO, Loudon MA. Damage control surgery in a non-trauma setting. Br J Surg, 2007, 94(7): 789-790.
45.	Zientara A, Domenghino AR, Schwegler I, et al. Interdisciplinary approach in emergency revascularization and treatment for acute mesenteric ischemia. BMC Surg, 2021, 21(1): 89.

1. Clair DG, Beach JM. Mesenteric Ischemia. N Engl J Med, 2016, 374(10): 959-968.
2. Nuzzo A, Huguet A, Corcos O. Modern treatment of mesenteric ischemia. Presse Med, 2018, 47(6): 519-530.
3. Corcos O, Castier Y, Sibert A, et al. Effects of a multimodal management strategy for acute mesenteric ischemia on survival and intestinal failure. Clin Gastroenterol Hepatol, 2013, 11(2): 158-165.e2.
4. 朱明杰, 王自强. 应重视培养急腹症诊断中急性肠缺血的病理生理与 CT 影像相关联的系统性思维模式. 中国普外基础与临床杂志, 2020, 27(12): 1473-1479.
5. Zettervall SL, Lo RC, Soden PA, et al. Trends in treatment and mortality for mesenteric ischemia in the United States from 2000 to 2012. Ann Vasc Surg, 2017, 42: 111-119.
6. Tilsed JV, Casamassima A, Kurihara H, et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg, 2016, 42(2): 253-270.
7. Kumar S, Sarr MG, Kamath PS. Mesenteric venous thrombosis. N Engl J Med, 2001, 345(23): 1683-1688.
8. 鞠乐乐, 颜玉, 周玲玲. 老年人缺血性肠病的临床特点及诊断分析进展. 微量元素与健康研究, 2020, 37(2): 70-72.
9. 肖毅, 陆君阳, 徐徕, 等. 肠系膜上血管系统解剖特点的临床研究. 中华外科杂志, 2019, 57(9): 673-680.
10. 施德兵, 符伟国. 肠系膜缺血性疾病的临床病理生理. 中国实用外科杂志, 2006(6): 405-407.
11. 林继平, 肖亦明, 唐承富, 等. 不同支架应用方式对肠系膜上动脉夹层动脉瘤患者的作用及预后对比分析. 心肺血管病杂志, 2020, 39(4): 436-439, 444.
12. Al-Diery H, Phillips A, Evennett N, et al. The pathogenesis of nonocclusive mesenteric ischemia: implications for research and clinical practice. J Intensive Care Med, 2019, 34(10): 771-781.
13. Mastoraki A, Mastoraki S, Tziava E, et al. Mesenteric ischemia: pathogenesis and challenging diagnostic and therapeutic modalities. World J Gastrointest Pathophysiol, 2016, 7(1): 125-130.
14. Bergan JJ, Dean RH, Conn J Jr, et al. Revascularization in treatment of mesenteric infarction. Ann Surg, 1975, 182(4): 430-438.
15. 龙禛朴, 余阳华, 陈霄霄, 等. 缺血性结肠炎临床特征分析: 附 101 报告. 中国普通外科杂志, 2020, 29(8): 979-986.
16. 张玮, 陈熹阳. 急慢性肠系膜缺血的诊治. 中华血管外科杂志, 2021, 6(3): 147-151.
17. Brandt LJ, Feuerstadt P, Longstreth GF, et al. ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI). Am J Gastroenterol, 2015, 110(1): 18-44.
18. Ten Heggeler LB, van Dam LJ, Bijlsma A, et al. Colon ischemia: right-sided colon involvement has a different presentation, etiology and worse outcome. A large retrospective cohort study in histology proven patients. Best Pract Res Clin Gastroenterol, 2017, 31(1): 111-117.
19. Yun WS, Kim YW, Park KB, et al. Clinical and angiographic follow-up of spontaneous isolated superior mesenteric artery dissection. Eur J Vasc Endovasc Surg, 2009, 37(5): 572-577.
20. Yoo J, Lee JB, Park HJ, et al. Classification of spontaneous isolated superior mesenteric artery dissection: correlation with multi-detector CT features and clinical presentation. Abdom Radiol (NY), 2018, 43(11): 3157-3165.
21. 付婷婷, 王炳元. 缺血性肠病研究进展. 中国临床医生, 2016, 44(12): 12-16.
22. Brandt LJ, Boley SJ. AGA technical review on intestinal ischemia. American Gastrointestinal Association. Gastroenterology, 2000, 118(5): 954-968.
23. Nuzzo A, Maggiori L, Ronot M, et al. Predictive factors of intestinal necrosis in acute mesenteric ischemia: prospective study from an intestinal stroke center. Am J Gastroenterol, 2017, 112(4): 597-605.
24. 宋弢, 沈平, 王西墨. 急性肠系膜血管缺血性疾病诊断的 Meta 分析. 中国中西医结合外科杂志, 2016, 22(3): 219-223.
25. Roussel A, Castier Y, Nuzzo A, et al. Revascularization of acute mesenteric ischemia after creation of a dedicated multidisciplinary center. J Vasc Surg, 2015, 62(5): 1251-1256.
26. 胡东来. D-二聚体联合肠脂肪酸结合蛋白早期诊断小儿绞窄性肠梗阻临床研究. 杭州: 浙江大学, 2017.
27. 张福先. 急性肠系膜缺血性疾病诊治现代策略. 中国实用外科杂志, 2020, 40(12): 1373-1375.
28. 孔祥凯, 张震. 超声诊断肠系膜上动脉血栓栓塞疾病的研究进展//中国超声医学工程学会第十届全国超声治疗及生物效应医学学术大会. 中国超声医学工程学会第十届全国超声治疗及生物效应医学学术大会论文汇编. 北京: 中国超声医学工程学会第十届全国超声治疗及生物效应医学学术大会, 2019: 41.
29. Expert Panel on Vascular Imaging, Reis SP, Majdalany BS, et al. ACR Appropriateness Criteria^® pulsatile abdominal mass suspected abdominal aortic aneurysm. J Am Coll Radiol, 2017, 14(5S): S258-S265.
30. van Noord D, Sana A, Moons LM, et al. Combining radiological imaging and gastrointestinal tonometry: a minimal invasive and useful approach for the workup of chronic gastrointestinal ischemia. Eur J Gastroenterol Hepatol, 2013, 25(6): 719-725.
31. Mehdorn M, Köhler H, Rabe SM, et al. Hyperspectral Imaging (HSI) in acute mesenteric ischemia to detect intestinal perfusion deficits. J Surg Res, 2020, 254: 7-15.
32. Emile SH. Predictive factors for intestinal transmural necrosis in patients with acute mesenteric ischemia. World J Surg, 2018, 42(8): 2364-2372.
33. Wu JM, Tsai MS, Lin MT, et al. High APACHE Ⅱ score and long length of bowel resection impair the outcomes in patients with necrotic bowel induced hepatic portal venous gas. BMC Gastroenterol, 2011, 11: 18.
34. Yang S, Fan X, Ding W, et al. Multidisciplinary stepwise management strategy for acute superior mesenteric venous thrombosis: an intestinal stroke center experience. Thromb Res, 2015, 135(1): 36-45.
35. Parry AH, Wani AH, Yaseen M. Acute mesenteric ischemia in severe coronavirus-19 (COVID-19): possible mechanisms and diagnostic pathway. Acad Radiol, 2020, 27(8): 1190.
36. 朱佩君, 薛静. 系统性红斑狼疮合并缺血性结肠炎 1 例. 中国实用内科杂志, 2020, 40(9): 786-788.
37. 王春喜, 李胜君, 魏志成, 等. 急性肠系膜上动脉栓塞患者血清甲状腺激素及 TSH 水平的观察. 放射免疫学杂志, 2013, 26(3): 258-261.
38. Nuzzo A, Corcos O. Management of mesenteric ischemia in the era of intestinal stroke centers: the gut and lifesaving strategy. Rev Med Interne, 2017, 38(9): 592-602.
39. Nuzzo A, Maggiori L, Paugam-Burtz C, et al. Enteral antibiotherapy reduces rates of intestinal resection in acute mesenteric ischemia. Gastroenterology, 2016, 150(4): S691.
40. 朱明洋, 郑翼德. 急性肠系膜上动脉栓塞诊断与治疗的进展. 中国血管外科杂志(电子版), 2020, 12(1): 77-80.
41. Yang S, Guo J, Ni Q, et al. Enteral nutrition improves clinical outcome and reduces costs of acute mesenteric ischaemia after recanalisation in the intensive care unit. Clin Nutr, 2019, 38(1): 398-406.
42. Orr NT, Endean ED. Part two: against the motion. an endovascular first strategy is not the optimal approach for treating acute mesenteric ischemia. Eur J Vasc Endovasc Surg, 2015, 50(3): 276-279.
43. Björck M, Koelemay M, Acosta S, et al. Editor’s choice - management of the diseases of mesenteric arteries and veins: clinical practice guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg, 2017, 53(4): 460-510.
44. Jansen JO, Loudon MA. Damage control surgery in a non-trauma setting. Br J Surg, 2007, 94(7): 789-790.
45. Zientara A, Domenghino AR, Schwegler I, et al. Interdisciplinary approach in emergency revascularization and treatment for acute mesenteric ischemia. BMC Surg, 2021, 21(1): 89.

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