肠系膜静脉血栓形成的危险因素和诊治现状分析

Risk Factors of Mesenteric Venous Thrombosis and Current Situation of Diagnosis and Treatment in China

目的了解中国人肠系膜静脉血栓形成(MVT)的危险因素和诊疗现状。方法检索《中文科技期刊数据库》和《万方数据库》2003—2007年所收录的文献,选取有关MVT的临床病例报告107篇,提取文献中病例资料进行统计分析。结果 107篇文献共计MVT978例,男∶女=1.9∶1,平均年龄47.9岁。最常见危险因素的构成比分别为:门静脉高压症28.9%(241/833)、脾切除18.8%(157/833)、血栓性静脉炎11.5%(96/833)。影像学检查确诊40.0%(391/978),剖腹探查确诊60.0%(587/978)。经外周静脉和肠系膜上动脉尿激酶溶栓成功率分别为83.9%(73/87)和90.0%(63/70)。手术治疗790例,术后未予抗凝或溶栓195例(24.7%),出院后仅34.7%患者口服华法令抗凝。结论门静脉高压症、脾切除和血栓性静脉炎可能是MVT最常见的危险因素;经外周静脉或肠系膜上动脉尿激酶溶栓是治疗早期MVT的有效手段;MVT诊断意识和MVT手术后抗凝治疗重要性的认识有待加强。

Objective To investigate risk factors of mesenteric venous thrombosis and current situation of diagnosis and treatment in China. Methods One hundred and seven case of mesenteric venous thrombosis reported in literature were analyzed. The literature from 2003 to 2007 were retrieved from Chinese Scientific and Technical Periodical Database and Wanfangdata. Results One hundred and seven papers included 978 MVT patients,male∶ female = 1. 9∶ 1,the average age was 47. 9. The most common risk factors were portal hypertension（ 28. 9% ） ,splenectomy（ 18. 8% ） and thrombophlebitis（ 11. 5% ） in 833 cases with integrated medical history. Final diagnosis was established by medical imageology （ 40. 0%） and exploratory laparotomy （ 60. 0%） . The achievement ratio of thrombolysis therapy was 83. 9% （ 73 /87） by peripheral vein and 90. 0% （ 63 /70） by superior mesenteric artery. 34. 7% patients took warfarin orally after discharge. Conclusions Portal hypertension,splenectomy and thrombophlebitis may be the most common risk factor for MVT; through peripheral vein or superior mesenteric artery urokinase thrombolytic therapy is an effective means of treatment of early MVT; MVT diagnostic awareness and anticoagulant therapy after surgery awareness of the importance is to be strengthened.