急性肠系膜静脉血栓形成继发肠缺血的临床特征及超声表现

Ultrasound features and clinical characteristics of intestinal ischemia secondary to acute mesenteric venous thrombosis

目的探讨急性肠系膜静脉血栓形成继发肠缺血的超声影像学表现。方法回顾性分析2016年1月至2019年6月北京协和医院经外科手术后病理学检查证实或CT检查证实为急性肠系膜静脉血栓形成继发肠缺血的11例患者的临床资料。男性7例,女性4例,年龄(52.8±11.9)岁(范围:34~81岁)。分析患者的临床特征、超声声像图表现,并与CT影像学表现进行比较。结果11例患者症状均表现为腹痛,便血2例,呕血1例,呕吐2例,腹泻1例。6例有腹膜炎体征。9例合并门静脉系统血栓形成。所有患者血常规白细胞计数及D-二聚体均升高。11例患者均接受CT检查,1例为平扫,未提示肠系膜上静脉血栓形成,10例增强扫描均显示肠系膜静脉血栓形成,诊断率为10/11;CT显示肠壁增厚11例,肠腔扩张5例。8例行肠系膜上静脉超声检查,7例明确诊断肠系膜上静脉血栓形成,诊断率为7/8。10例行腹部超声检查,5例明确显示肠道病变,包括肠壁增厚4例,肠腔扩张1例;10例显示腹腔积液,与CT一致。10例行手术治疗,1例行保守治疗。结论超声可以准确诊断肠系膜上静脉主干血栓形成,显示肠壁增厚、肠腔扩张及腹腔积液等肠道缺血表现。

Objective To examine the ultrasound features and clinical characteristics of the intestinal ischemia secondary to acute mesenteric venous thrombosis(AMVT).Methods From January 2016 to June 2019,11 patients were diagnosed as intestinal ischemia secondary to AMVT confirmed by surgical pathology or CT in Peking Union Medical College Hospital.The patients included 7 males and 4 females,aging of(52.8±11.9)years(range:34 to 81 years).The clinical characters and ultrasound features were retrospectively reviewed.Results Abdomen pain was the chief complaint of all patients.Other complaints include 2 cases of blood in the stool,1 case of hematemesis,2 cases of vomiting,1 case of diarrhea.Six patients showed rebound pain on physical examination.All patients had elevated white blood cell account and D-Dimer.Nine patients had a thrombosis in the portal vein simultaneously.All 11 patients underwent the CT scan including 10 contrast-enhanced CT.Mesenteric venous thrombosis was detected in 10 cases who underwent contrast-enhanced CT imaging.On CT imaging,11 patients demonstrated intestinal wall thicken,5 patients showed intestinal dilation.Eight patients underwent superior mesenteric venous ultrasound examination.Of them,7 patients were correctly diagnosed as AMVT.Of the 10 patients who underwent abdominal ultrasound,5 patients showed intestinal lesions including intestinal wall thicken in 4 patients and intestinal dilation in 1 patient.Peritoneal fluid was detected in 10 patients by ultrasound,which was consistent with CT.Ten patients underwent surgical procedures while 1 patient received conservative treatment.Conclusion Ultrasound is an accurate imaging method in diagnosing superior mesenteric vein thrombosis and can detect intestinal wall thickening,intestinal dilation,and peritoneal fluid.