Yavuz Atakan SEZER, Orkut GÜÇLÜ, Volkan YÜKSEL, Suat CANBAZ, Serhat HÜSEYİN, Taha ÖZKARA, Elif Çiçek YILMAZ

Superior mezenterik arter tromboembolisi sonrası cerrahi sonuçları etkileyen faktörler

Amaç: Bu çalışmada, akut mezenterik iskemi nedeniyle ameliyat edilen hastalarda superior mezenterik arter tromboembolisinin ameliyat sonuçları ve mortaliteyi etkileyen faktörler değerlendirildi. Çalışma planı: Ocak 2011 - Aralık 2016 tarihleri arasında akut mezenterik iskemi tanısı konan ve ameliyat edilen ardışık 28 hasta (15 erkek, 13 kadın; ort. yaş 71.2±10 yıl; dağılım 48 -89 yıl) çalışmaya alındı. Açık revaskülarizasyon işlemlerinin sonuçları ve mortaliteyi etkileyen faktörler retrospektif olarak değerlendirildi. Bulgular: En sık şikayet karın ağrısını takiben bulantı ve kusma idi. Tanı, bilgisayarlı tomografi anjiyografi ve Dupleks ultrasonografi ile doğrulandı. Hastaların çoğunluğunda tromboembolektomi yapılırken, uygun hastalarda otolog safen ven baypas ve transpozisyon uygulandı. Revaskülarizasyon işlemleri 10 hastada bağırsak rezeksiyonunu engelledi. Solunum, böbrek ve kalp patolojilerine bağlı mortalite oranı %35.7 idi. Ameliyat sonrası solunum yetmezliği ve karın ağrısı başlangıcından sonra altı saatten daha geç hastaneye başvuru, mortaliteyi etkileyen faktörler olarak bulundu. Sonuç: Çalışma sonuçlarımız ameliyat sonrası solunum yetmezliği ve karın ağrısı başlangıcından sonra geç başvurunun ameliyat sonrası mortalite ile ilişkili olduğunu gösterirken, bağırsak rezeksiyon gereksiniminin mortalite oranlarına bir etkisi gözlenmedi. Çalışma sonuçlarımıza göre, keşif amaçlı laparotomi ve tromboembolektominin, bağırsak canlılığını değerlendirmede ve mezenterik perfüzyonun devamında önemli olduğu kanısındayız.

Factors affecting surgical outcomes after superior mesenteric artery thromboembolism

Background: In this study, we aimed to evaluate the operative results of superior mesenteric artery thromboembolism and influential factors for mortality in patients undergoing surgery for acute mesenteric ischemia.Methods: Between January 2011 and December 2016, 28 consecutive patients (15 males, 13 females; mean age 71.2±10 years; range 48 to 89 years) diagnosed and operated for acute mesenteric ischemia were included in the study. The results of open revascularization procedures and influential factors for mortality were retrospectively analyzed.Results: Abdominal pain was the major complaint, followed by nausea and vomiting. The diagnosis was confirmed by computed tomography angiography and Duplex ultrasonography. Thromboembolectomy was performed in the majority of the patients, while autologous saphenous vein bypass and transposition were performed in eligible patients. Revascularization procedures prevented bowel resection in 10 patients. The mortality rate was 35.7% due to respiratory, renal, and cardiac pathologies. Postoperative respiratory failure and admission to hospital later than six hours after the onset of abdominal pain were identified as the factors affecting mortality.Conclusion: Our study results showed that postoperative respiratory failure and late admission after the onset of abdominal pain were associated with postoperative mortality, whereas intestinal resection requirement did not contribute to the mortality rates. Based on our study results, we suggest that exploratory laparotomy and thromboembolectomy are essential in evaluating the viability of the bowel and in continuation of the mesenteric perfusion.

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