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, 王自強. 應重視培養急腹癥診斷中急性腸缺血的病理生理與 CT 影像相關聯的系統性思維模式. 中國普外基礎與臨床雜志, 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.	鞠樂樂, 顏玉, 周玲玲. 老年人缺血性腸病的臨床特點及診斷分析進展. 微量元素與健康研究, 2020, 37(2): 70-72.
9.	肖毅, 陸君陽, 徐徠, 等. 腸系膜上血管系統解剖特點的臨床研究. 中華外科雜志, 2019, 57(9): 673-680.
10.	施德兵, 符偉國. 腸系膜缺血性疾病的臨床病理生理. 中國實用外科雜志, 2006(6): 405-407.
11.	林繼平, 肖亦明, 唐承富, 等. 不同支架應用方式對腸系膜上動脈夾層動脈瘤患者的作用及預后對比分析. 心肺血管病雜志, 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.	龍禛樸, 余陽華, 陳霄霄, 等. 缺血性結腸炎臨床特征分析: 附 101 報告. 中國普通外科雜志, 2020, 29(8): 979-986.
16.	張瑋, 陳熹陽. 急慢性腸系膜缺血的診治. 中華血管外科雜志, 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. 缺血性腸病研究進展. 中國臨床醫生, 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. 急性腸系膜血管缺血性疾病診斷的 Meta 分析. 中國中西醫結合外科雜志, 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.	胡東來. D-二聚體聯合腸脂肪酸結合蛋白早期診斷小兒絞窄性腸梗阻臨床研究. 杭州: 浙江大學, 2017.
27.	張福先. 急性腸系膜缺血性疾病診治現代策略. 中國實用外科雜志, 2020, 40(12): 1373-1375.
28.	孔祥凱, 張震. 超聲診斷腸系膜上動脈血栓栓塞疾病的研究進展//中國超聲醫學工程學會第十屆全國超聲治療及生物效應醫學學術大會. 中國超聲醫學工程學會第十屆全國超聲治療及生物效應醫學學術大會論文匯編. 北京: 中國超聲醫學工程學會第十屆全國超聲治療及生物效應醫學學術大會, 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, K?hler 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, 薛靜. 系統性紅斑狼瘡合并缺血性結腸炎 1 例. 中國實用內科雜志, 2020, 40(9): 786-788.
37.	王春喜, 李勝君, 魏志成, 等. 急性腸系膜上動脈栓塞患者血清甲狀腺激素及 TSH 水平的觀察. 放射免疫學雜志, 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, 鄭翼德. 急性腸系膜上動脈栓塞診斷與治療的進展. 中國血管外科雜志(電子版), 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.	Bj?rck 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, 王自強. 應重視培養急腹癥診斷中急性腸缺血的病理生理與 CT 影像相關聯的系統性思維模式. 中國普外基礎與臨床雜志, 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. 鞠樂樂, 顏玉, 周玲玲. 老年人缺血性腸病的臨床特點及診斷分析進展. 微量元素與健康研究, 2020, 37(2): 70-72.
9. 肖毅, 陸君陽, 徐徠, 等. 腸系膜上血管系統解剖特點的臨床研究. 中華外科雜志, 2019, 57(9): 673-680.
10. 施德兵, 符偉國. 腸系膜缺血性疾病的臨床病理生理. 中國實用外科雜志, 2006(6): 405-407.
11. 林繼平, 肖亦明, 唐承富, 等. 不同支架應用方式對腸系膜上動脈夾層動脈瘤患者的作用及預后對比分析. 心肺血管病雜志, 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. 龍禛樸, 余陽華, 陳霄霄, 等. 缺血性結腸炎臨床特征分析: 附 101 報告. 中國普通外科雜志, 2020, 29(8): 979-986.
16. 張瑋, 陳熹陽. 急慢性腸系膜缺血的診治. 中華血管外科雜志, 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. 缺血性腸病研究進展. 中國臨床醫生, 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. 急性腸系膜血管缺血性疾病診斷的 Meta 分析. 中國中西醫結合外科雜志, 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. 胡東來. D-二聚體聯合腸脂肪酸結合蛋白早期診斷小兒絞窄性腸梗阻臨床研究. 杭州: 浙江大學, 2017.
27. 張福先. 急性腸系膜缺血性疾病診治現代策略. 中國實用外科雜志, 2020, 40(12): 1373-1375.
28. 孔祥凱, 張震. 超聲診斷腸系膜上動脈血栓栓塞疾病的研究進展//中國超聲醫學工程學會第十屆全國超聲治療及生物效應醫學學術大會. 中國超聲醫學工程學會第十屆全國超聲治療及生物效應醫學學術大會論文匯編. 北京: 中國超聲醫學工程學會第十屆全國超聲治療及生物效應醫學學術大會, 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, K?hler 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, 薛靜. 系統性紅斑狼瘡合并缺血性結腸炎 1 例. 中國實用內科雜志, 2020, 40(9): 786-788.
37. 王春喜, 李勝君, 魏志成, 等. 急性腸系膜上動脈栓塞患者血清甲狀腺激素及 TSH 水平的觀察. 放射免疫學雜志, 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, 鄭翼德. 急性腸系膜上動脈栓塞診斷與治療的進展. 中國血管外科雜志(電子版), 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. Bj?rck 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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Advances in the diagnosis and treatment of mesenteric ischemia under the multidisciplinary diagnosis and treatment model

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