急性肠系膜静脉血栓形成的临床诊治策略(附19例报告)

Diagnosis and treatment of acute mesenteric venous thrombosis: experience of 19 cases

目的总结急性肠系膜静脉血栓形成(AMVT)的治疗经验及效果。方法回顾性分析北京市中关村医院及河南科技大学第一附属医院自2000年1月至2012年6月收治的AMVT患者的临床资料。结果共纳入19例AMVT患者,彩色多普勒超声检出率58.8%,腹部CT检出率91.7%。5例患者行保守治疗,14例患者行手术治疗。发生手术并发症7例(50.0%),包括短肠综合征、肠瘘、多器官功能障碍综合征和切口感染。本组患者误诊率为21.1%,死亡率为21.1%。结论可疑AMVT患者应尽早行腹部增强CT检查,早期抗凝治疗是控制疾病发展的关键,对于透壁性肠坏死患者应立即手术治疗。

Objective To summarize the treatment experience and effect of the acute mesenteric venous thrombosis（ AMVT）. Methods The clinical data of patients with AMVT from January 2000 to June 2012 were analyzed retrospectively. Results 19 cases were included into the research. The detectable rates of color Doppler ultrasonography and CT for AMVT were 58. 8% and 91. 7%,respectively. Five cases underwent conservative treatment,and 14 cases underwent surgical treatment. The postoperative morbidity rate was 50%,including short bowel syndrome in 3 patients,intestinal fistula in 2 patients,multiple organ dysfunction syndrome in 1 patient,and incision infection in 1 patient. The misdiagnosis rate was 21. 1%. The in- hospital mortality rate was 21. 1%. Conclusion The patient who was suspicious of AMVT should perform abdominal enhanced CT examination as quickly as possible. Early anticoagulation therapy is the key point to control the development of AMVT.Laparotomy should be performed if the intestinal necrosis occurred.