肠系膜上静脉血栓形成18例临床分析

Clinical analysis of 18 cases with superior mesenteric venous thrombosis

目的探讨肠系膜上静脉血栓形成(SMVT)的诊断和治疗方法。方法回顾分析1997年1月至2006年12月18例SMVT患者的临床资料。全部行彩色多普勒超声检查,12例行增强CT检查,1例行选择性肠系膜上动脉造影。15例表现为急腹症,均给㈣手术治疗。3例未出现急腹症表现,均给予非手术治疗。结果彩色多普勒超声检查诊断率为77.8%,CT为100%。15例行手术治疗,其中12例痊愈,3例在手术后因为中毒性休克和多器官功能衰竭死亡。非手术治疗的3例均痊愈。15例患者随访6个月～3年均无复发。结论门静脉血流缓慢、涉及门静脉系统的上腹部手术以及血液高凝状态等是SMVT常见的诱因。增强CT检查对SMVT的早期诊断和鉴别诊断有重要意义。早期抗凝和溶栓治疗对提高患者的生存率有明显的作用。出现急腹症表现的患者需急诊手术治疗。手术后继续抗凝、溶栓治疗对溶解肠系膜静脉内残留的血栓和预防SMVT复发有重要意义。

Objective To explore the diagnosis and treatment of superior mesenteric venous thrombosis （SMVT）. Methods Clinical datum of 18 cases with SMVT from Jan 1997 to Dec 2006 were retrospectively analyzed. All patients accepted color Doppler uhrasonography, 12 cases of them with post-contrast CT scan, 1 case of them with selective superior mesenteric arterigraphy. 15 patients with the acute abdominal disease underwent operative treatment. 3 cases without the acute abdominal disease were treated with non-surgical management. Resuits The detectable rate of color Doppler uhrasonography and CT for SMVT was 77.8% and 100% respectively. 15 cases were accepted with operation, 12 of them were cured, 3 cases died of poisoned shock and multiple organic failure after operation. 3 cases treated with non-surgical management were cured. For the cured 15 cases, there was no recurrence of SMVT in following up for six months to three years. Conclusion Slow portal vein flow, super abdominal operation involving portal vein system and high-coagnlated blood are the common inducement of SMVT. Post-contrast CT scan is very important to early diagnosis and differential diagnosis of SMVT. Early anti-coagulated and thrombosis-dissolved treatment can increase the survival rate of SMVT patients. Emergency operation is demanded for the patients displayed with the acute abdominal disease. Prolongation of anti-coagulated and thrombosis-dissolved treatment after operation plays the important role for dissolving the remnant thrombosis in superior mesenteric vein and preventing the recurrence of SMVT.