急性肠系膜静脉血栓形成及其治疗方式选择

Choice of treatment option for acute mesenteric venous thrombosis

由于肠系膜静脉血栓形成(MVT)发生症状隐匿,易延误诊断,使得该疾病有着较高的病死率。认真询问有无血栓形成高危因素,结合影像学检查,特别是血管多普勒超声、CT血管成像(CTA)有助于早期明确诊断。MVT诊断明确后,应立即全身抗凝治疗;对于有腹膜炎肠坏死的病人应手术切除坏死肠管;在单纯抗凝治疗无效或症状加重情况下,如无溶栓禁忌,可选择导管介入技术实施局部血栓部位的溶栓治疗,以促进肠系膜和门静脉循环的恢复。

Due to the hidden symptoms of mesenteric venous thrombosis （MVT），it is easy to delay the diagnosis resulting in high mortality. Careful inquiry of thrombosis risk factors combined with imaging examination, especially the vascular Doppler and CTA，can help to diagnose early. After diagnosis of MVT，systemic anticoagulant therapy should be administered immediately. For patients with peritonitis and intestinal necrosis，emergency resection of necrotic bowel should be performed. If anticoagulant therapy is invalid，or even lead to exacerbation of symptoms，thrombolytic treatment of thrombosis site should be chosen by vascular intervention technique if no contraindication exists，so as to promote the recovery of mesenteric and portal venous circulation.