肠系膜上静脉血栓形成的诊断和治疗

目的探讨肠系膜上静脉血栓形成(MVT)的诊断及治疗。方法总结15例MVT的诊治经验,从病因、诊断和治疗等方面进行分析。结果初诊多数表现为急腹症,症状和体征不相符。9例经手术病理证实,6例术前确诊,3例误诊,7例治愈,2例死亡。6例急性MVT诊断确立后立即采用抗凝溶栓等保守治疗,5例治愈,1例中转手术治愈。结论该病症状和体征无特异性。诊断更主要依靠影像学检查(彩色超声多普勒、CT、磁共振成像、血管造影)发现肠系膜上静脉的栓子征象来确立。急性MVT在肠缺血尚未导致透壁性肠坏死、肠穿孔时,抗凝溶栓治疗可行,如有急性腹膜炎时中转手术。在肠坏死时,早期切除坏死肠段,包括静脉阻塞的肠系膜部分,术中、术后抗凝治疗,是提高治愈率的重要措施。

The diagnosis and treatment of superior mesenteric venous thrombosis

Objective To study the diagnosis and treatment of MVT.Methods The etiology,diagnosis and treatment of 15 patients with mesenteric venous thrombosis(MVT) which had been treated in our hospital since 1993 were analyzed.Results The most patients suffered the acute abdominal pain and sign were in the discordance.9 patients were operated on and the diagnosis was confirmed pathologically.The diagnosis was established preoperatively in 6 cases.3 cases were misdiagnosed,7 were cured,2 died.Nonoperation treatment was used for 6 acute MVT once diagnosis was established,5 cases were cured,1 secondary operation.Conclusion MVT is an uncommon disease,its symptoms and signs nonspecific.The accurate diagnosis is relied on medical imageology to find embolus of superiormesenteric veins.Anti-coagulation and thrombolytic therapy for MVT is feasible when the initial diagnosis is certain and bowel infarction has not let to transmural necrosis and bowel perforation.Patients underwent secondary operation when indicated.Early operating for the resecting bowl gangrene involving its mesentery,early application of anticoagulant therapy are essential to improvement of prognosis.