目的探讨急性肠缺血的病因、诊断和治疗方法的选择。方法对2008年1月～2011年7月本科室收治的21例急性肠缺血患者的临床资料进行回顾性分析。肠系膜上动脉(SMA)血栓性闭塞16例,其中中心型9例,周围型2例,混合型5例,合并SMA硬化斑块7例;孤立性SMA夹层5例。结果中心型9例:5例行取栓,其中2例行小肠部分切除;导管溶栓4例,溶栓后支架置入3例,死亡1例,因小肠系膜缘出血行小肠部分切除1例。混合型5例:行剖腹探查肠切除3例,死亡1例,术后发生短肠综合征1例;2例行导管溶栓,其中1例死于心肌梗死,另1例辅以支架置入。周围型2例:药物溶栓1例,导管溶栓、碎栓1例,均成功。孤立性SMA夹层支架治疗3例,保守治疗成功2例。结论 SMA主干夹层病变首选保守治疗,如果症状不缓解,应积极治疗,以腔内治疗为主;急性肠缺血SMA主干栓塞,首选手术取栓;有时短段主干血栓形成或栓塞,也可以采用导管溶栓,必要时辅以支架。 Objective To explore the etiology, diagnosis and treatment of acute intestinal ischemia. Methods The clinical data of 21 patients with acute intestinal ischemia treated in our department from January 2008 to July 2011 were retrospectively analyzed. There were 16 cases of thrombus occlusion of the superior mesenteric artery (SMA), including 9 cases of central type, 2 cases of peripheral type, 5 cases of mixed type and 7 cases of SMA sclerosis. 5 cases of solitary SMA dissection. Results The central type of 9 cases: 5 cases were taken thrombectomy, 2 cases of small intestine resection; catheter thrombolysis in 4 cases, thrombolysis stent implantation in 3 cases, 1 died, due to small intestinal mesenteric hemorrhage partial resection 1 example. 5 cases of mixed type: 3 cases underwent laparotomy for laparotomy, 1 case died, 1 case had short bowel syndrome after operation; 2 cases received catheter thrombolysis, 1 case died of myocardial infarction, and the other 1 case was implanted with stent . Peripheral type 2 cases: drug thrombolysis in 1 case, catheter thrombolysis, broken bolt in 1 case, were successful. Three cases were treated with solitary SMA sandwich scaffolds and two cases were treated conservatively. Conclusions SMA trunk dissection is the first choice of conservative treatment. If symptoms do not alleviate, active treatment should be given to intracavitary therapy. Acute intestinal ischemia with SMA main embolization may be the first choice of surgical thrombectomy. Sometimes short-term trunk thrombosis or embolization may also be used Catheter thrombolysis, supplemented with a stent if necessary.