急性肠系膜静脉血栓形成的诊治

The diagnosis and treatment of acute messentric venous thrombosis

目的探讨急性肠系膜静脉血栓形成(AMVT)的诊治方法。方法回顾性分析1 9 9 0年1 0月—2 0 0 4年8月期间收治的2 2例急性MVT的临床资料,其中1 6例术前经CT或超声检查确诊,6例于剖腹探查术中确诊。全组有1 6例经手术治疗,其中4例采用美蓝判断肠坏死的范围;有6例采用介入治疗,其中4例采用经肠系膜上动脉溶栓治疗,2例采用经皮经肝途径在肠系膜静脉内行血栓清除术。结果手术组4例死亡,3例死于脓毒性休克,1例死于多器官功能衰竭。介入组6例均治疗成功,血栓清除满意。结论急性MVT的诊治关键在于早期诊断,CT检查是准确的方法。对于已经有肠坏死的患者,手术切除是首选的方法,术中美蓝确定坏死肠管范围有一定价值。对于无坏死型MVT,介入治疗是一种有价值的方法。

Objective To evaluate the diagnosis and management of acute mesenteric venous thrombosis （AMVT）. Methods A retrospective analysis was made on the clinical data of 22 patients with AMVT treated from October 1990 to September 2004. Among them, 16 cases were diagnosed before operation by CT and uhrasounograpby, and 6 cases during laparotomy. Sixteen patients underwent surgical operation and 6 patients received interventional tbromblytic therapy （4 cases were treated by superior mesenteric artery tbrombolysis with urokinase and the other 2 patients underwent percutaneous transhepatic removal of supeior mesenteric vein thrombus ）. Results The 6 patients who received interventional therapy were all cured successfully. After operation, 3 patients died from toxic shock and 1 patient died from multiple organ failure in the 16 operated patients. Condusions The most important of all to the prognosis of AMVT is diagnosis and management in its early stage. The best management for the necrotic bowel type of AMVT is operative resection. During the operation injection of methylene blue is of some value to determine the extent of bowel necrosis. For patients with non-necrotic AMVT interventional therapy is of value.