急性肠系膜上静脉血栓形成合并肠坏死诊断及手术治疗体会

Initial experiences of the diagnosis and surgical treatment of bowel necrosis by acute superior mesenteric venous thrombosis

目的总结急性肠系膜上静脉血栓形成(SMVT)合并肠坏死的诊断及手术治疗经验。方法回顾性分析2010年6月1日至2016年7月1日收治的12例SMVT合并肠坏死的临床资料。结果 12例患者术前影像学检查有9例均明确诊断,3例剖腹探查术中证实。出院前行门静脉肠系膜上静脉CT和计算机断层摄影术血管造影(CTA)复查,未见新的血栓形成,血管通畅。平均住院时间14~20 d。2例患者术后继发短肠综合征,无手术死亡及再次手术。全部患者得到随访,随访6个月~1年无1例复发。结论 SMVT合并肠坏死早期及时诊断和围手术期治疗的规范化处理,可避免再手术或形成继发性短肠综合征,尤为重要。

Objectives To summarize initial experiences of the diagnosis and surgical treatment of bowel necrosis by acute superior mesenteric venous thrombosis（SMVT）.Methods From 1st June 2010 to 1st July 2016,clinical data of 12 patients with bowel necrosis by acute SMVT were analyzed retrospectively.Results 9 of 12 cases were definitely diagnosed by preoperative imaging,while 3 cases were diagnosed after laparotomy.Before discharge from hospital,It was CT/CTA of portal vein and mesenteric vein were reexamined,which showed no new thrombosis.The hospital stay ranged from 14 to 20 days.Postoperative short-bowel syndromes occurred in 2 cases.No reoperation and perioperative death occurred.All of 12 patients were followed up for 6 months to 1 year,without relapse.Conclusions It is particularly important that early diagnosis of bowel necrosis of acute SMVT and standardized processing during perioperative treatment might help to avoid reoperations and development of secondary short-bowel syndromes.