急性肠系膜静脉血栓形成的诊断与治疗

目的探讨急性肠系膜静脉血栓形成(mesenteric venous thrombosis,MVT)的诊断与治疗。方法对15例急性MVT患者的临床资料进行回顾性分析。结果在15例患者中,男10例,女5例,平均年龄48岁。发病至入院平均时间50 h。患者均表现为不同程度的上腹痛,同时伴有恶心、呕吐和血便等。腹部体征与症状的严重程度不符。术前诊断12例,其中10例经CT诊断,2例经超声诊断,其余3例于剖腹探查术中确诊。本组中10例经手术治疗,5例在CT监测下进行介入溶栓治疗。13例治愈；2例死亡,分别死于中毒性休克和短肠综合征所致的多器官功能衰竭。结论急性MVT的关键在于早期诊断,CT检查是目前最准确的方法。对于出现肠坏死的MVT患者应首选手术治疗,未坏死者可在CT监测下进行介入溶栓治疗。

The diagnosis and treatment of acute messentric venous thrombosis

Objective To explore the diagnosis and treatment of acute messentric venousthrombosis(MVT). Methods A retrospective study was carried out in 15 patients with acute MVT.Result They were 10 men and 5 women, with mean age of 48 years old.The mean time from onset to admission was 50 hours.All of the patients had different degrees of abdominal pain accompanied by nausea,vomiting and bloody stool.The symptoms were not in accordance with the abdomen sign.Ten patients were diagnosed by CT,2 by US,and 3 by laparotomy.Ten patients underwent surgery,the others underwent interventional thrombolytic therapy under CT.Two patients died of toxic shock and of multiple organ dysfunction syndrome respectively,and 13 were cured.Conclusion Early diagnosis is key to treat acute MVT,and CT is the best method.To patients with necrotic intestine,surgical operation is the first choice,and intervential thrombolytic therapy under CT can be used on patients without necrosis.