门静脉高压症肠系膜血栓形成致绞窄性肠梗阻的诊治(附11例报告)

The Diagnosis and Treatment of Strangulated Intestinal Obetruction caused by Mesentery Thrombosis

目的总结因门静脉高压症引起的肠系膜血栓形成致绞窄性肠梗阻的诊断和治疗经验.方法 1993年～2004年间共收治绞窄性肠梗阻154例,其中因门静脉高压肠系膜血栓形成致绞窄性肠梗阻11例,对其诊断和治疗作一回顾性分析.结果 11例患者均出现不同程度的恶心、呕吐、上腹部胀痛,仅7例出现剧烈腹痛,5例出现不明原因的发热.所有患者均行手术治疗证实为绞窄性肠梗阻,原因均为门静脉高压症所致的肠系膜血栓形成,其中2例为保守治疗24h后未见明显好转而剖腹探查时发现.行部分小肠切除8例,3例术中发现肠系膜广泛血栓形成而放弃手术.术后死亡5例,3例为广泛血栓形成患者,2例为小肠部分切除术后肝功能衰竭死亡.结论门静脉高压症肠系膜血栓形成所致的急性绞窄性肠梗阻起病隐匿,常导致诊断困难而延误病情.同时应加强术后护肝、支持治疗,尽量降低死亡率.

Objective To investigate diagnosis and treamaent of strangulated intestinal obetruction caused by mesentery thrombosis. Method 154 patients with strangulated intestinal obetruction was reviewed from 1993 - 2004, in whom 11 patients caused by mesentery thrombosis were analysed. Result All patients presented obdominal pain and vomitus and was confirmed strangulated intestinal obetruction caused by mesentery thrombosis with operation. In this patients, 8 underwent part of small intestine excision, 3 patients underwent open-closed operation becaused of the whole small intes- tine necrosis caused by intensive mesentery thrombosis. 5 died after operation. Conclusion The diagnosis of strangulated intestinal obetruction caused by mesentery thrombosis was difticult because of the slow disease processes , and usually bring out severe outcomes. It is necessary to take some measure to get over the danger duration after operation.