急性和亚急性肠系膜上静脉-门静脉血栓的介入治疗

目的评价介入技术治疗急性和亚急性肠系膜上静脉（superior mesenteric vein，SMV）-门静脉（portal vein，PV）血栓形成的疗效。方法对21例急性和亚急性SMV—PV血栓形成患者进行介入治疗。选择经颈静脉途径经肝穿刺门静脉[即通过经颈静脉肝内门脉系统分流术（transjugular intrahepatic portosystemic shuntapproach，TIPS途径）]介入治疗（12例）和经导管肠系膜上动脉（superior mesenteric artery，SMA）溶栓治疗（9例）。结果治疗成功19例，无严重并发症。11例经TIPS途径治疗的患者于治疗结束时造影显示大部分血栓被清除，门静脉系统有血流通过，临床症状缓解。1例虽然SMV—PV恢复血流，但12d后死于腹腔脓肿、MODS。经导管SMA内溶栓治疗9例，术后症状逐渐改善8例，无效1例。结论经TIPS途径介入技术和经导管SMA溶栓是治疗急性和亚急性SMV—PV血栓形成的有效方法。     

肠系膜上静脉血栓11例临床分析

目的 总结肠系膜上静脉血栓(MVT)临床诊断与治疗的经验.方法 回顺性分析1999年至2008年新疆维吾尔自治区人民医院收治的11例MVT患者的临床资料.单纯MVT 3例,肠系膜卜静脉合并门静脉血栓2例,肠系膜上静脉合并门静脉及脾静脉血栓6例.结果 9例患者经抗凝治疗后临床症状明显减轻或消失.2例肠系膜上静脉合并门静脉及脾静脉血栓患者,1例经抗凝治疗后症状未见明显改善,自动出院;1例诊断明确后未行抗凝治疗,1周后发展为急腹症并行剖腹探查,行坏死肠管切除肠吻合+肠系膜卜静脉取栓术,患者痊愈出院.结论 单纯MVT 患者以抗凝治疗多可痊愈,而对于合并门静脉、脾静脉血栓患者,在临床抗凝治疗同时,严密观察体征变化,做好随时手术准备.     

肠系膜上静脉血栓形成的诊治分析

目的　探讨肠系膜上静脉血栓形成的诊治问题。方法　总结分析我院 15年来所收治的 4例临床资料。结果　本组病例都由剖腹探查证实 ,再手术 1例 ,切除小肠最长达 430 cm,1例术后并发肠瘘 ,2例短肠综合征。手术后 3例治愈 ,1例死于输血后肝炎。结论　正确认识该病的临床表现 ,及时把握手术时机 ,妥善处理术后并发症 ,有助于进一步提高疗效     

肠系膜上静脉血栓形成10例诊治分析

目的分析和探讨肠系膜上静脉血栓（MVT）形成的诊断和治疗方法。方法回顾分析我院1999年至2007年收治的10例MVT患者。结果继发性MVT患者占发病的绝大多数（70％,7／10例）,早期症状不典型,主要为腹胀、腹痛、恶心、呕吐、腹泻、便血,误诊率60％（6／10）。9例手术患者均出现小肠坏死,切除坏死肠段和术后的抗凝是治疗关键。对比增强的CT是该病的首选检查方法。结论MVT是少见急腹症,容易导致诊治延误,对比增强CT是首选检查,有助于早期诊断。手术和抗凝是治疗成功的关键;早期在未出现腹膜炎之前可采用保守的溶栓治疗。     

肝移植术后门静脉狭窄-肠系膜上静脉血栓的影像诊断

Portal vein stricture complicated with superior mesenteric venous thrombosis is rarely seen in clinical practice. On December 26, 2009, a 51-year-old male patient who had a liver transplantation history was admitted to The General Hospital of Chinese People's Armed Police Forces with the chief complaint of intermittent abdominal pain and diarrhea.A plain and enhanced CT scan showed that the portal vein was constrictive and thrombosis had formed in the main trunk of the superior mesenteric vein, and varicose veins were seen in surrounding tissues of the esophagus. Edema was observed at the end of the ileum and cecum. The results of colonoscopy showed inflammatory changes and varicose veins of the colon. The patient received medical treatment. The thrombosis was dissolved 9 days later, and all symptoms disappeared 12 days later.     

急性肠系膜静脉血栓形成保守治疗临床分析

目的探索急性肠系膜静脉血栓形成保守治疗指征及有效规范治疗方案。方法对本院近2年多来收治的13例急性肠系膜静脉血栓形成患者中的12例采用保守治疗,总结临床资料及有效的保守治疗方案。结果 12例急性肠系膜静脉血栓形成患者中11例采用保守治疗成功,成功率91.7%。结论如能在肠系膜静脉血栓形成患者出现肠坏死前确诊,并施以早期抗凝及＂消化道休息＂为核心的治疗方案,绝大多数患者可以通过保守治疗得到治愈。     

急性肠系膜上静脉血栓的进阶式诊治

急性肠系膜上静脉血栓（ASMVT）是一种少见的胃肠道缺血性疾病。随着血管增强CT、血管造影以及腹腔镜探查等诊断技术的不断进步,其发病率不断提高,更多患者能够获得早期诊断。抗凝、介入技术以及损伤控制性手术的综合应用不断提升着临床疗效。当前,诊断技术主要为血管增强CT,同时以血管造影对血栓范围及程度进行评估,必要时行腹腔镜直接评估肠道缺血情况;治疗则以全身抗凝为基石,局部介入导管抗凝和溶栓使血管再通为主要治疗核心,辅以肠系膜动脉解痉及多种腔内操作治疗,必要时行坏死肠管手术切除加两端造口或腹腔开放等损伤控制性手术;形成ASMVT进阶式诊治模式,有望能进一步提高临床整体疗效。本文将该治疗模式的最新研究进展作一综述。     

急性肠系膜上静脉血栓形成12例诊治体会

作者通过回顾性总结临床资料探讨了急性肠系膜上静脉血栓形成的病因及治疗。自１９７８－１９９５年作者所在单位共施治１２例急性肠系膜上静脉血栓形成，男生９例，女性３例，男女比例为３；１。发病年龄自２１－６４岁，平均３９．４岁。６例伴有门静脉高压，４例曾行脾切除，４例合并血液高凝状态，１例原因未明确。     

介入治疗门静脉-肠系膜上静脉广泛血栓形成一例

门静脉和肠系膜静脉广泛血栓形成是较少见疾病 ,可继发于腹腔感染、胰腺炎、肿瘤侵犯、门脉高压症、腹部外科术 (如脾切除、门 腔分流、肝移植术 )后、血液病等 ,急性病人可因侧支建立不良而发生肠梗死 ,未经及时治疗者死亡率高达 70 %。近年 ,欧美有些作者报道用介入微创技术治疗急性门静脉和肠系膜上静脉血栓 ,获得优良效果 ,国内尚无类似报告。我们最近用介入治疗方法成功救治 1例急性门静脉和肠系膜上静脉广泛血栓形成病人 ,现报告如下。1.病历简介 :病人 ,女性 ,38岁 ,以腹痛、腹胀、恶心、呕吐 2d入院。病人2周前因巨脾合并脾静脉阻…     

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目的 探讨诊治急性肠系膜上静脉血栓形成的有效方法。方法 回顾性分析１９７８年８月至１９９９年８月收治的１９例急性肠系膜上静脉血栓形成的诊断和治疗方法。结果 １９９５年前诊治的１２例中有５例死亡,１９９５年后行不同长度肠切除术＋外周抗凝治疗及经肠系膜上动脉插管持续应用尿激酶溶栓治疗,７例病人的存活。结论 急性肠系膜上静脉血栓形成应尽早诊治,选择性肠系膜上动脉造影并留置导管持续给予溶栓治疗是一具有诊断     

Portal vein thrombosis

Portal vein thrombosis (PVT) is a complication of hepatic disease and a potentially lethal complication of splenectomy. The reported incidence of this complication is low (~1%). However, its true incidence may have been underestimated due to difficulty in making the diagnosis. Herein we report the case of a 19 year-old woman who presented with a 2-year history of idiopathic thrombocytopenic purpura (ITP). Because she had become refractory to medical therapy, she underwent laparoscopic splenectomy. She was discharged on postoperative day 2 after an uncomplicated procedure. She did well, complaining only of mild backache, until postoperative day 21, when she presented with nausea, vomiting, and leukocytosis. CT showed PVT and superior mesenteric vein thrombosis. Despite heparin and fluid administration, her condition worsened. At laparotomy, she had diffuse small bowel edema and congestion. At a second-look procedure 24 h later, nearly all her jejunum and ileum were necrotic. After three procedures, she was left with 45 cm of proximal and 10 cm of distal small bowel. Bowel continuity was restored 8 weeks later. She continued on warfarin anticoagulation therapy for 1 year. Postsplenectomy PVT is most often seen following splenectomy for myeloproliferative disorders and almost never after trauma. The large splenic vein stump and the hypercoagulable state in patients with splenomegaly are thought to be contributory. The presentation of PVT is vague, without defining signs or symptoms. Color-flow Doppler and contrast-enhanced CT scans are the best methods for the nonoperative diagnosis of PVT. Aggressive thrombolysis offers the best hope for clot lysis and maintenance of bowel viability. Even vague symptoms must be considered seriously following splenectomy.     

急性肠系膜上静脉血栓形成的诊断与治疗

目的 加深对急性肠系膜上静脉血栓形成(AMVT)导致急腹症严重性的认识,探讨提高疗效的措施。方法 对13例AMVT临床特点、治疗方法和效果进行分析比较。结果 入院均诊断为急腹症,但术前能确诊仅2例,拟诊1例,行小肠部分切除11例,其中小肠广泛切除3例,仅作剖腹探查2例。治愈10例,死亡3例。随诊3个月～14年,无复发,无短肠综合征发生。结论 AMVT临床表现无特异性,术前确诊困难。腹痛与腹部体征不符、WBC大于20×10~9/L时应警惕本病。彩色多普勒对诊断有较大帮助。充分认识此病,争取早期诊断及时手术是提高疗效关键,术后抗凝溶栓可防止复发。     

急性肠系膜静脉血栓形成的诊断和治疗

目的　探讨肠系膜静脉血栓形成 (MVT)的诊断和治疗。方法　总结 11例肠系膜静脉血栓形成病人的诊治经验 ,结合文献分析MVT的发病机理、临床特点、诊断和治疗。结果　 11例病人均以急腹症或肠梗阻收住院 ,术前明确诊断者 8例 ,其中发病 2 4h内确诊者仅 2例。全部患者行手术治疗 ,均治愈 ,随访无复发。结论　提高对该病的认识是早期诊断的关键 ,及时手术行肠切除是治疗本病的有效方法 ,切除足够范围肠段及早期抗凝治疗是预防复发的根本措施。     

肝移植中门静脉-内脏曲张静脉吻合在门静脉机化血栓患者的应用

目的:探讨门静脉-内脏曲张静脉吻合在门静脉机化血栓患者肝移植中的应用。方法:对门静脉和肠系膜上静脉均完全被机化血栓阻塞的7例患者实施肝移植,其中3例供体门静脉-曲张冠状静脉吻合;2例髂静脉搭桥供体门静脉和脾门旁曲张的静脉吻合;1例采用供体门静脉-胆总管前曲张静脉吻合;1例供体门静脉—曲张的胃网膜右静脉吻合。结果:7例手术全部成功。1例术后7d死于多脏器功能衰竭,但是门静脉血流一直通畅。1例术后6个月发现吻合口狭窄,术后9个月采用经皮肝穿刺门静脉支架置入治愈;其余患者分别随访12～22个月,门静脉血流均通畅,无狭窄或血栓形成,肝、肾功能正常。结论:肝移植中对门静脉和肠系膜上静脉均完全被机化血栓阻塞的患者,行供体门静脉-曲张内脏静脉吻合可取得良好疗效。     

成人再通肝圆韧带与自体门静脉及肠系膜上静脉长度及管径对比研究

目的将成人再通肝圆韧带（LTH）长度及管径与自体门静脉及肠系膜上静脉进行对比分析,研究其用于自体门静脉（PV）及肠系膜上静脉（SMV）节段性替代的可行性。方法随机选取25例成人上腹部手术患者,术前行强化CT检查,运用血管重建技术重建门静脉及肠系膜上静脉,在重建图像上测量其长度,并自近肝端向远肝端,于每厘米中部依次测量其管径。术中切取其肝圆韧带并进行扩张再通,30cmH2O压力下测量再通后肝圆韧带的长度及其每厘米管径。将两者的长度及对应部位的管径进行对比分析。结果门静脉与肠系膜上静脉的长度之和为7.32～11.1（9.40±1.32）cm,门静脉最大平均直径为8.8～13.9（11.83±1.56）mm,肠系膜上静脉最小平均直径为5.0～8.1（7.18±0.92）mm。再通肝圆韧带的长度为7.6～10.8（9.01±0.97）cm,最大平均内径为10.0～16.1（12.55±1.81）mm,最小平均内径为5.6～7.5（6.47±0.80）mm。70%以上的病例其肝圆韧带与自体门静脉及肠系膜上静脉管径的差值波动范围在30%以下。再通肝圆韧带长度及对应测量位置管径与门静脉或肠系膜上静脉无统计学差异。结论肝圆韧带可扩张再通,再通肝圆韧带具有与门静脉及肠系膜上静脉相匹配的长度及管径,具备了用于门静脉及肠系膜上静脉节段性修复重建的解剖学基础。     

肠系膜上静脉血栓形成18例临床分析

目的探讨肠系膜上静脉血栓形成（SMVT）的诊断和治疗方法。方法回顾分析1997年1月至2006年12月18例SMVT患者的临床资料。全部行彩色多普勒超声检查,12例行增强CT检查,1例行选择性肠系膜上动脉造影。15例表现为急腹症,均给予手术治疗。3例未出现急腹症表现,均给予非手术治疗。结果彩色多普勒超声检查诊断率为77．8％,CT为100％。15例行手术治疗,其中12例痊愈,3例在手术后因为中毒性休克和多器官功能衰竭死亡。非手术治疗的3例均痊愈。15例患者随访6个月～3年均无复发。结论门静脉血流缓慢、涉及门静脉系统的上腹部手术以及血液高凝状态等是SMVT常见的诱因。增强CT检查对SMVT的早期诊断和鉴别诊断有重要意义。早期抗凝和溶栓治疗对提高患者的生存率有明显的作用。出现急腹症表现的患者需急诊手术治疗。手术后继续抗凝、溶栓治疗对溶解肠系膜静脉内残留的血栓和预防SMVT复发有重要意义。     

Portal and mesenteric vein thrombosis after portal vein embolization in a patient with protein S deficiency

Portal vein embolization can be performed safely, and so far no major complications have been reported. We report an extremely rare complication of portal vein embolization, a case of portal and mesenteric thrombosis in a 65-year-old patient with protein S deficiency. Right portal vein embolization was carried out prior to extended right hepatectomy for advanced gallbladder carcinoma involving the hepatic hilus. Computed tomography 14 days after embolization revealed massive thrombosis of the portal and the superior mesenteric veins. A protein S deficiency was found by means of an extensive workup for hypercoagulable state. Portal vein embolization may have triggered a cascade of events that was expressed as portal and mesenteric vein thrombosis resulting from deficiency of protein S. It may be better to determine the concentrations of such coagulation regulators prior to portal vein embolization.