急性肠系膜静脉血栓形成8例临床分析

Clinical Analysis of 8 Cases of Acute Mesenteric Venous Thrombosis

目的探讨急性肠系膜静脉血栓形成(AMVT)的诊治要点。方法回顾性分析我院1995年7月至2003年6月经手术确诊的8例AMVT的临床特点及诊治情况。结果8例术前均以急腹症就诊,疑诊AMVT2例,8例均手术后确诊。1例为肠系膜上静脉主干血栓形成,全小肠坏死,术后2d死亡。余7例部分肠系膜静脉栓塞及肠坏死,6例治愈,1例并发双下肢深静脉血栓形成。5例明确病因。结论AMVT大多数以急腹症就诊,早期腹痛明显而体征轻微是其临床特点,临床诊断较困难。对有急性弥漫性腹膜炎、可疑肠坏死和血流动力学不稳的患者应立即手术治疗。

Objective To explore an appropriate management for acute mesenteric venous thrombosis（AMVT）. Methods 8 cases of AMVT were confirmed by operation in our hospital in the period July 1995 - June 2003. We retrospectively analyzed the clinical manifestation ,diagnosis,treatment and outcome. Results 8 patients all presented with acute peritonitis. 2 cases were suspectod AMVT before operation. 8 cases were confirmed by operation. 1 patient was AMVT of main trunk of superior mesenteric venous and total extensive intestinal necrosis. 2 days after the operation the patient died of severe metabolic derangements. 7 patients were AMVT of ramification of superior mesenteric venous and part intestinal necrosis. 6 of them were healing well and one was complicated by both extremitas inferior deep venous thrombosis. 5 cases were identified the causes of AMVT. Conclusion Most of AMVT are complained of abdominal pain. Laboratory exams are not very helpful in making in the diagnosis. The characteristic of AMVT is severe diffuse abdominal pain out of proportion to the physical findings on examination. The indications for surgery in patients with AMVT include signs of peritonitis,questionable bowel infarction and hemodynamic instability.