急性肠系膜上静脉血栓形成的诊治体会(附29例报告)

Experience of diagnosis and treatment on acute superior mesenteric venous thrombosis in 29 cases

目的 探讨急性肠系膜上静脉血栓形成（SMVT）的诊治方法.方法 回顾性分析我院1990年1月～2005年6月间收治的29例SMVT患者的临床资料.结果 29例SMVT患者,年龄18～74岁（平均61.2岁）.主要症状有腹痛、腹胀、呕吐、发热、呕血和便血.主要体征有腹部膨隆、肠鸣音减少、腹膜刺激征、腹穿抽出血性液、白细胞计数升高.误诊率72.4%（21/29）,复发率24.1%（7/29）,死亡率27.6%（8/29）.结论 SMVT无特异性的临床表现,容易误诊.螺旋CT确诊率高,应该作为SMVT诊断的首选检查.早期诊断、早期进行抗凝治疗是降低死亡率和提高治愈率的关键,术后抗凝同样重要.发生肠坏死时,应进行以手术治疗为主的综合治疗.

[Objective] The aim of this study was to search the profitable measures of diagnosis and treatment of acute superior mesenteric venous thrombosis（SMVT）. [Methods] A retrospective analysis was carried out to analyze the clinical data of 29 cases with this diagnosis in our hospital from January 1990 to June 2005. [Results] Median age of the patients was 61.2 years, ranged from 18 to 74 years. Clinical presentation for all patients was abdominal pain, with nausea and vomiting being the second symptom in frequency, The main physical conditions were abdominal expansion and peritonitis. The misdiagnosis rates were 72.4%, recurrence rates were 24.1%, mortality rates were 27.6%. [Conclusions] SMVT lacks of specific clinical feature and is easy to misdiagnosis. Spiral CT should be taken as the priority examination for its higher positive diagnostic rate. Makeing diagnosis in the early state and taking anticoagulation immediately is the key to improve the prognosis of SMVT. The post-operative anticoagnlation is also important, if the bowel infarction taken place, laparotomy is strongly recommended.