肠系膜上静脉血栓形成致肠坏死的诊治分析(附32例报道)

Analysis for Diagnosis and Therapy of Intestinal Necrosis Caused by Superior Mesenteric Venous Thrombosis(Reports of 32 Cases)

目的探讨肠系膜上静脉血栓形成(superior mesenteric venous thrombosis,SMVT)所致肠坏死的早期诊断和外科治疗。方法回顾性总结和分析了32例SMVT所致肠坏死病例的临床资料,其中原发性SMVT6例,继发性SMVT 26例;9例伴随门静脉血栓形成,有24例术前经影像学检查确诊为SMVT;均经手术治疗,其中9例术中使用了Fogarty导管取栓,术后予抗凝溶栓治疗。结果 1例发生短肠综合征;1例死亡;其余30例均病愈出院。结论 SMVT是一种临床少见的肠缺血性疾病,病因复杂,早期诊断困难,往往因延误治疗而发生肠坏死;及时行手术切除坏死小肠是一种行之有效的方法,术中、术后给予抗凝溶栓治疗可有效减少复发。

Objective To discuss the early diagnosis and surgery of intestinal necrosis caused by superior mesenteric venous thrombosis（SMVT）.Methords The clinical data of 32 patients with intestinal necrosis caused by SMVT were reviewed retrospectively and analyzed,which included 6 cases of primary SMVT,26 cases of secondary SMVT,9 cases with pylethrombosis,24 patients had been dignosed definitely as SMVT by imageology examination before surgery.All the patients accepted surgery therapy,within which 9 patients accepted Fogarty catheter,and anticoagulation and thrombolytic therapy were administrated postoperatively.Results All patients had recovered except for one with short bowel syndromle and one died.Conclusions SMVT is a rarely ischemic intestinal disease,which has complicated pathogenesis and difficulty in early diagnosis.Intestinal necrosis often occurs as a result of delayed treatment and the effective way is to cut off necrotic intestines in time.Intra-and postoperative anticoagulation and thrombolytic therapy could reduce recurrency effectively.