急性肠系膜静脉血栓形成并肠坏死18例诊治体会

Experience of Diagnosis and Treatment of Acute Mesenteric Venous Thrombosis with Intestinal Necrosis of 18 Cases

目的探讨急性肠系膜血栓形成的诊断及不同程度肠缺血坏死的手术方式选择。方法回顾性分析西京消化病医院消化外科2011年8月~2015年3月收治的18例急性肠系膜静脉血栓形成并肠坏死患者的诊治经过。结果其中9例患者行肠切除肠吻合术,5例患者行肠切除+空-回肠端侧T型吻合+远端回肠残端造瘘术,2例患者行肠切除+近端造瘘+远端造瘘置入营养管术,1例患者行肠切除+近端造瘘远端关闭术,1例患者仅行开关腹术。18例患者中,除一例自动出院外,其余均康复出院。6例患者于6~9个月后行造瘘还纳术。随访有1例发生短肠综合症。结论急性肠系膜静脉血栓形成在临床上较为少见,症状隐匿,易延误诊治;对于急性肠系膜血栓形成肠坏死的患者,应早期手术切除坏死肠管,剩余肠管可一期吻合或肠切除+空-回肠端侧T型吻合+远端回肠残端造瘘术,术后早期积极抗凝治疗。

Objective To discuss the diagnosis and therapy of acute mesenteric venous thrombosis and the operational mode.Methods The clinical data of 18 patients with intestinal necrosis caused by actue mesenteric venous thrombosis hospitalized from August 2011 to march 2015 in Xi Jing hospital were analyzed restropectively.Of this 18 patients, nine underwent bowel resection and anastomosis, five underwent bowel resection, end-to-side type T anastomosis of jejunum and ileum combined with residual ileum ostomy, two underwent bowel resection,jejunum ostomy combined with terminal ileum ostomy and feeding tube placement, one underwent bowel resection, jejunum ostomy combined with the residual ileum closure and the other one underwent sham-operated.Results Among the 18 cases,the rest of the hospital were discharged from the hospital.6 patients underwent fistulostomy after 6~9 months. 1 cases of short bowel syndrome were followed up.Conclusion Acute mesenteric venous thrombosis necrotic bowel disease has no characteristic symptoms and is easily misdiagnosed. Early diagnosis and bowel resection and anastomosis or end-to-side type T anastomosis of jejunum and ileum combined with residual ileum ostomy combined with anti-coagulation therapy are critical.