急性肠系膜上静脉血栓形成的治疗现状

Treatment status of acute superior mesenteric vein thrombosis

尽管当今的相关理论和医疗技术飞速发展,急性肠系膜上静脉血栓形成(ASMVT)仍是一种早期诊断较困难并且潜在致命的急腹症。在及时诊断的前提下,目前的治疗方法包括保守、介入和外科治疗。情况尚可的患者采取抗凝、全身溶栓、扩血管等保守治疗即可取得良好的效果,其中以抗凝最为基础和必要;经颈静脉、经皮、经股动脉三种微创介入途径和多种操作的组合使血管内介入治疗也成为治疗ASMVT的重要手段;有肠坏死和腹膜炎等情况较差的患者则需要开腹探查,切除坏死肠管切除和(或)切开肠系膜上静脉取栓。多学科多种方法联合治疗可以显著提高疗效和改善预后。目前对于治疗并没有共识,本综述旨在描述ASMVT的治疗现状。

Despite the rapid development of relevant theories and medical technology,acute superior mesenteric vein thrombosis(ASMVT)is still a relatively difficult and potentially fatal acute abdominal disease for early diagnosis.On the premise of timely diagnosis,the current treatment methods include conservative,interventional and surgical treatment.The patients with acceptable conditions can achieve good results by conservative treatment such as anticoagulation,systemic thrombolysis and vasodilation,among which anticoagulation is the most basic and necessary.The combination of three minimally invasive interventional approaches via jugular vein,percutaneous and femoral artery and multiple operations makes endovascular interventional therapy an important means to treat acute superior mesenteric vein thrombosis.Patients with poor conditions such as intestinal necrosis and peritonitis need resection of necrotic bowel and/or incision of superior mesenteric vein for thrombectomy.The combination of multiple disciplines and methods can significantly improve the curative effect and prognosis.There is currently no consensus on treatment,and this review aims to describe the current status of treatment for ASMVT.