脾切除后肠系膜静脉血栓性肠梗阻的诊治

Diagnosis and treatment of intestinal obstruction by mesentery thrombus after excision of spleen

目的 :探讨肠系膜静脉血栓性肠梗阻的诊断及治疗方法。方法 :对 8例肠系膜静脉血栓性肠梗阻进行回顾性分析。结果 :8例均有腹痛 ,全腹压痛 ,后期均出现腹膜刺激症 ,腹部X线片均见肠胀气和小气液平。周围血Hb >15 0g L 2例 ,血小板升高 6例。 6例行部分小肠切除吻合术 ,静脉切开取栓术和对症处理各 1例。 4例死亡。结果表明 ,病因为脾切除术后血液高凝状态 ;发病常不典型 ,应综合临床检查及早诊断 ,B超检查及血管造影具有重要诊断价值 ;治疗以手术为主 ,可获良好结果。结论 :对各种原因的脾切除 ,尤其是肝硬化、门脉高压症的脾切除后出现腹痛等症状 ,进一步检查术前可获确诊 。

Objective:To discuss the diagnosis and treatment of intestinal obstruction by mesentery thrombus after excision of spleen.Methods:Eight cases of intestinal obstruction by mesentery thrombus after excision of spleen in the past 30 years were analyzed retrospectively.Results:All the eight cases had abdominal pain,the whole abdominal tenderness,and peritoneum stimulation sign after a delay;the abdominal radiography exhibited abdominal flatulence and small gas fluid levels.The hemoglobin of the blood was more than 150g/L in two cases and elevated platelet was found in six cases.Partial intestine excision and anastomosis were operated on six cases;venotomy and embolectomy was carried out in one case and heteropathy in the other.Four cases were died.The common etiology was the hypercoagulable state after excision of the spleen;the onset of illness was often atypical and the diagnosis should be made as early as possible according to the clinical examinations.B mode ultrasonography and angiography were very helpful to the diagnosis.Surgery was the main method and the result was good.Conclusion:Precautions should be taken if abdominalgia occurred after the excision of the spleen and the final diagnosis could be obtained by further examination and good result could be gotten by promptly surgery.