急性肠系膜上静脉血栓形成的诊治分析(附36例)

Diagnosis and treatment of acute mesenteric vein thrombosis:a report of 36 cases

目的探讨诊治急性肠系膜上静脉血栓形成(SMVT)的有效方法。方法对重庆医科大学附属第一医院血管外科2006年1月~2014年12月收治的SMVT的36例住院病例进行回顾分析。结果总死亡5例(13.9%),治疗好转出院31例(86.1%),再次手术7例(19.4%)。保守治疗15例,14例治疗好转出院;手术治疗治疗15例,好转出院12例。保守和手术治疗患者中5例再次手术,2例术后患者腹痛、腹胀不缓解,再次手术治疗后出现全身严重感染合并急性肾衰竭(AFR),最终死亡;1例入院病情危重急诊行坏死肠切除肠吻术后48 h内死于MODS;介入治疗6例,治疗好转出院5例,2例再次手术,1例SMA置管溶栓术后6天合并严重颅内出血死亡。另1例治疗40天出现DVT,并发生肺栓塞和肺部感染,出现ARDS死亡。结论 SMVT术前诊断困难,对不明原因急性腹痛者应及时怀疑本症;早期发现、早期治疗方能提高本病的治愈效果。病程早期可采用溶栓、取栓治疗,出现肠坏死征象者应及时手术,并予以抗凝治疗。

Objective To summarize the experience in treatment of acute superior mesenteric vein thrombosis(SMV T)and explore the better treatment approach.Methods A retrospective analysis were conducted in 36 patients with SMV T admitted to the Department of V ascular Surgery of the First A ffiliated Hospital of Chongqing Medical University from January 2006 to December 2014.Results Of 36 cases,5(13.9%)were dead,31(31.6%)got improved,7(19.4%)were re-operated.Conservative treatment was in 15 cases and 14 were cured.Surgical approach was in 15 cases and 12 discharged.Five cases got re-operated in 30 cases of conservative treatment and surgical procedure,in which 2 patients died of severe systemic infection with acute renal failure after reoperation because of abdominal pain and abdomi-nal distension after primary surgery,one case died of MODS within 48 hours after emergency necrolytic bowel resection.Interventional treatment was performed in 6 cases,5 cases discharged,2 cases were re-operated,and one case of SMA catheterized thrombolysis for 6 days died of severe intracranial hemorrhage.In addition,one case of DV T occurred 40 days after treatment,and did of pulmonary embolism,pulmonary infection and A RDS.Conclusion The preoperative diagnosis of SMV T is not easy.For patients with unexplained acute abdominal pain,this disease should be suspected in time.Early detection and treatment can improve the outcomes of this disease.Thrombolysis and thrombectomy can be used early in the course of the disease.Patients with signs of intestinal necrosis should undergo surgery in time and be treated with anticoagulation.