肠系膜静脉血栓形成29例诊疗体会

Experience in diagnosing and treating 29 patients with mesenteric venous thrombosis

目的探讨肠系膜静脉血栓形成(MVT)的早期诊断及治疗方法。方法回顾性分析自1986年1月至2006年1月29例MVT患者的临床资料。结果MVT29例患者中有21例为急性症状包括腹痛腹胀、恶心呕吐、便血等。彩色多普勒超声的检出率81.0%;腹部CT/MR的检出率为100%。非手术治疗包括抗凝、溶栓及对症等,治愈率81.3%;手术治疗13例,包括肠切除和切除肠系膜静脉血栓,手术并发症23.1%(3/13例),其中顽固性腹水2例,进食后腹痛1例。术后随访3个月至5年,复发6例,系出院后自行停用抗凝药物。结论彩色多普勒超声和CT/MR扫描对MVT的早期诊断有较高的诊断价值;抗凝治疗和手术是MVT有效的治疗手段。

Objective To investigate the methods of early diagnosis and treatment of the mesenteric venous thrombosis （MVT）. Methods The clinical data of 29 cases with MVT from January 1986 to January 2006 were analyzed retrospectively. Results In 29 cases of MVT, 21 cases had manifestions of acute abdomen, including abdominal pain and distention, nausea, vomiting, and heme-positive stool, et al. The detectable rates of transabdominal color Doppler uhrasonography and CT/MR for MVT were 81.0% and 100% respectively. Non-surgical managements for MVT were anticoagulation, dissolving thrombus, symptomatic and supportive therapies, and the rate of cure was 81.3%. 13 patients underwent surgical treatments including resection of the infracted bowel and open mesenteric venous, and 3 cases （23.1%） had complications of surgical management, including ascites in 2 patients and postprandial abdominal pain in 1 patient. After follow-up from 3 months to 5 years,6 patients had MVT recurrence because of ceasing anti-coagulation treatment. Conclusion Color Doppler uhrasonography and CT/MR scanning are valuable diagnostic methods for MVT, and anticoagulation treatment and operation are effective managements.