急性肠系膜上静脉血栓的进阶式诊治

Step-up strategy for diagnosis and treatment of acute ;superior mesenteric venous thrombosis

急性肠系膜上静脉血栓（ASMVT）是一种少见的胃肠道缺血性疾病。随着血管增强CT、血管造影以及腹腔镜探查等诊断技术的不断进步，其发病率不断提高，更多患者能够获得早期诊断。抗凝、介入技术以及损伤控制性手术的综合应用不断提升着临床疗效。当前，诊断技术主要为血管增强CT，同时以血管造影对血栓范围及程度进行评估，必要时行腹腔镜直接评估肠道缺血情况；治疗则以全身抗凝为基石，局部介入导管抗凝和溶栓使血管再通为主要治疗核心，辅以肠系膜动脉解痉及多种腔内操作治疗，必要时行坏死肠管手术切除加两端造口或腹腔开放等损伤控制性手术；形成ASMVT进阶式诊治模式，有望能进一步提高临床整体疗效。本文将该治疗模式的最新研究进展作一综述。

Acute superior mesenteric venous thrombosis is rare. With advance in CT venography, angiography and diagnostic laparoscopy, the incidence of acute superior mesenteric venous thrombosis has increased worldwide with more access to early diagnosis. The use of anticoagulatory medication, interventional radiology, and damage control approach has resulted in better clinical outcomes. At present, the new step-up approach for acute superior mesenteric venous thrombosis includes CT venography as the main diagnostic technique, anticoagulation as the cornerstone of therapy, local transcatheter thrombolytic therapy as the key recanalization method, and adjunctive use of arterial spasmolysis and various endovascular manipulation and damage control surgery by intestinal resection plus jejunostomy and ileostomy or open abdomen. This strategy may further improve clinical outcomes. This review will present the most recent advance in this strategy.