| 特集名 | 血管関連の潰瘍性腸病変 | |
|---|---|---|
| 題名 | 急性腸管虚血 (1) 腸間膜動脈閉塞症および腸間膜静脈血栓症 | |
| 発刊年月 | 2012年 09月 | |
| 著者 | 室野 浩司 | 東京大学腫瘍外科 |
| 著者 | 須並 英二 | 東京大学腫瘍外科 |
| 著者 | 渡邉 聡明 | 東京大学腫瘍外科 |
| 【 要旨 】 | 上腸間膜動脈閉塞症，上腸間膜静脈血栓症はいずれも腸管が広範囲に壊死することのあるきわめて予後不良の血管疾患である．腸管壊死が生じると腸管切除が必要となるため，早期発見・早期治療が重要となる．診断は腹部CT検査で行われることが多いが，腸管壊死の有無によって治療方針が大きく異なるため，発症時間，症状，臨床検査所見も踏まえて慎重に治療方針を判断する必要がある．本稿では本疾患に対する診断並びに治療方針を中心に概説する． | |
| Theme | Intestinal ulcerations related to vascular disorders | |
|---|---|---|
| Title | Mesenteric arterial occlusion and mesenteric venous thrombosis | |
| Author | Koji Murono | Department of Surgical Oncology, Faculty of Medical Sciences, University of Tokyo |
| Author | Eiji Sunami | Department of Surgical Oncology, Faculty of Medical Sciences, University of Tokyo |
| Author | Toshiaki Watanabe | Department of Surgical Oncology, Faculty of Medical Sciences, University of Tokyo |
| [ Summary ] | Both superior mesenteric arterial occlusion and superior mesenteric venous thrombosis are life-threatening disorders, which may cause a wide range of bowel necrosis symptoms. Early diagnosis and rapid revascularization are important to prevent bowel necrosis. Both disorders are often diagnosed with computed tomography. Thrombosis or embolism are detected as filling defects in the superior mesenteric artery or vein. If ischemia in the bowel is irreversible, intramural gas in the small intestine or hepatic portal venous gas may be observed. Risk factors for superior mesenteric arterial occlusion include atherosclerosis and arrhythmia. Because necrosis may occur within 12 hours and the difficulties associated with early diagnosis, mortality rates range from 31 % to 78 % and have remained at this high level for decades. Thrombectomy or thrombolytic therapy are effective if early diagnosis is possible. Bowel ischemia is reversible at these times. If this is not possible necrotic bowels must be resected. Risk factors for superior mesenteric venous occlusion include hypercoagulable states such as protein C and S deficiencies, portal hypertension, previous abdominal surgery and pancreatitis. Unlike superior mesenteric arterial occlusion, necrosis does not occur for three to five days. The first choice of treatment is anticoagulant therapy. Necrotic bowels must be resected in cases with severe symptoms or irreversible bowel ischemia. |
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