妊娠合并血栓性肠坏死误诊分析与处置

Analysis for erroneous diagnosis and treatment of intestine necrosis

目的 探讨妊娠并发肠系膜静脉血栓形成致肠坏死的误诊分析及诊治。方法 对 5例妊娠并发肠系膜静脉血栓形成致肠坏死的原因进行分析。结果 5例均行剖腹探查术 ,4例行坏死肠段肠切除肠吻合术 ,1例剖宫产术后发现肠管变紫 ,行温盐水保护肠管 ,静滴肝素 ,血循环好转 ,未行肠切除。治愈 4例 ,死亡 1例。结论 该病少见 ,发病急 ,临床症状与体征不相符 ,诊断困难 ,易被误诊 ,若未及时诊治 ,可危及母体及胎儿生命。对中晚期妊娠者 ,出现腹部不适伴呕吐血水样物 (不含血块 )或剧烈腹痛 ,而腹膜刺激征阴性 ,应迅速排除产科疾病 ,立即按本病剖腹探查 ,达到早期诊断与治疗、减少死亡率。

Objective To study the erroneous diagnosis and the treatment of the intestine necrosis led by the pregnancy with the mesentery venae thrombosis.Methods The causes of 5 intestine necrosis led by the pregnancy with the mesentery venae thrombosis have been analysed.Results The five cases were carried out the Laparo-exploration who were found four treated by the intestinal anastomosis with resecting the necrosis intestine and one with the intestine tube to be prupled after the uterotomy which was put into lukewarm saline water and the heparin was dripped intravenously.When the blood circulation was on the mend,the intestine was’nt resected.Four were Cured and one was died.Conclusion The disease occurrs few and comes upon acutely.The clinical symptom does’nt agree with the sign that will be diagnosed erroneously.It will endanger the mother’s body and the fetal lift if you couldn treat it in time.When the pregnancy at the middle and later period feels unwell in abdomen with the blood water vomitus(without sladged blood) or severe abdominal pain & there is a peritoneum stimulated as a negative reaction,the obtetrical disease should be forgotten swiftlv and the laparo-exploration as the above-mentioned should be made at once so that the early diagnoses and treatment could be made and rdeuce the death rate.