腹部手术后急性肠系膜静脉血栓形成17例临床分析

目的探讨腹部手术后急性肠系膜血栓形成的相关因素及诊治方法。方法对17例腹部手术后肠系膜血栓形成患者的临床资料作回顾性分析。结果 17例急性肠系膜静脉血栓形成发生于腹股沟疝术后6例、肠梗阻术后6例、脾切除术后5例。17例均行腹部CT增强扫描（CTA）检查发现肠系膜静脉血栓形成。15例行手术治疗,2例仅行抗凝、溶栓治疗;其中16例痊愈出院,1例死亡。结论腹部手术后患者易发生急性肠系膜静脉血栓形成,腹部CTA可作为其诊断的首选检查,手术及抗凝是本病的主要治疗方法。     

急性肠系膜上静脉血栓形成6例的诊治体会

目的：探讨急性肠系膜上静脉血栓形成的诊断和治疗。方法：总结1991～2002年收治的6例急性肠系膜上静脉血栓形成的诊治经验，并从病因、病理、诊断和治疗等方面进行分析。结果：1例非手术治疗，5例经手术病理证实；术前误诊4例，确诊1例。6例均治愈出院，随访8～196个月均无复发。结论：该病大部分诊断困难。警惕本病症状与体征不相符的特点及CT、多普勒超声检查对早期诊断有重要意义。手段治疗切除坏死肠段，静脉取栓及术中、后抗凝溶栓是提高治愈率、防止复发的重要方法，尚未引起肠坏死、穿孔时，非手段治疗是可行的。     

肠系膜静脉血栓形成的临床特点分析

目的分析急性肠系膜静脉血栓(acute mesenteric venous thrombosis,AMVT)和慢性肠系膜静脉血栓(chronic mesenteric venous thrombosis,CMVT)的临床特点。方法对首都医科大学附属友谊医院1980年10月至2005年12月确诊的33例肠系膜静脉血栓(MVT)患者的临床资料进行了分析,并结合文献,总结MVT的临床特点和治疗方法。结果33例MVT中,慢性肠系膜静脉血栓11例,年龄32~78岁(平均46.6岁),无急腹症的表现,均是在腹部CT检查中发现肠系膜静脉血栓;另22例为AMVT患者,年龄19~75岁(平均48.9岁)。主要症状和体征为腹痛、腹胀、腹部膨隆、腹膜刺激征,呕吐68.2%(15/22),发热36.4%(8/22)。误诊率59.1%(13/22),手术治疗17例,死亡7例,治愈10例;溶栓治疗5例痊愈。结论早期腹部CT结合肠系膜上动脉造影可对早期AMVT做出正确的诊断,早期溶栓或手术治疗可以降低病死率。     

急性肠系膜静脉血栓形成30例临床分析

目的分析急性肠系膜静脉血栓形成的临床特点和治疗。方法对我院30例急性肠系膜静脉血栓患者的临床资料进行回顾性分析,并结合文献总结急性肠系膜静脉血栓的临床特点、诊断及治疗方法。结果30例急性肠系膜静脉血栓患者,年龄19～78岁,平均年龄51．9岁。手术治疗19例,死亡7例;溶栓治疗11例,放弃治疗1例。结论腹部CT可对早期急性肠系膜静脉血栓做出正确的诊断,早期溶栓或手术治疗可以降低死亡率。     

经肠系膜上动脉介入溶栓治疗急性门静脉系血栓的疗效观察

对收治的23例急性门静脉系静脉血栓形成患者经肠系膜上动脉插管持续应用尿激酶溶栓治疗,结果14例(60.9%)患者治愈,5例(21.7%)显影欠佳但侧枝循环较前丰富而临床症状明显缓解,4例(17.4%)症状较重而效果欠佳行外科手术治疗,患者2 a生存率为86.9%.认为经肠系膜上动脉介入溶栓治疗门静脉系血栓形成具有损伤小、溶栓能力强的特点,是治疗症状较轻患者的首选疗法.     

抗凝、溶栓治疗在急性肠系膜静脉血栓形成中的价值

急性肠系膜静脉血栓形成（MVT）是一种少见的肠系膜血管阻塞性疾病,起病隐匿,缺乏特异临床症状和体征,以往很难早期诊断.当病程进展出现肠坏死时,虽可经剖腹探查确诊,但术后并发症、死亡率及复发率均较高.近几年,随着医学影像学的飞速发展和对本病认识的不断提高,使MVT的早期诊断成为可能,也使本病的治疗模式发生了转变.抗凝、溶栓治疗在本病的治疗中有着极其重要的意义,我们回顾性分析我院收治的22例急性MVT病历资料,旨在探讨抗凝溶栓治疗在本病中的价值.     

脑静脉血栓形成17例诊治体会

目的探讨脑静脉血栓形成的有效诊治方法。方法根据临床表现及颅脑影像学检查诊断脑静脉血栓形成患者17例,3例采用低分子肝素皮下注射溶栓,14例持续静脉泵入普通肝素,据APTT值调整普通肝素剂量,常规使用2~3周。肝素静脉泵入不能阻止病情进展者采取介入溶栓,肝素及介入溶栓后给予华法令口服抗凝治疗。结果 17例肝素治疗2~3周,14例脑静脉窦血栓再通,2例足量普通肝素静脉泵入效果不佳采取介入溶栓再通,1例合并血液病治疗效果不佳。随访半年,12例预后好,生活自理;3例留有残疾,不能行走及言语;1例死亡;1例失访。结论颅脑MRI联合MRV是诊断脑静脉血栓的可靠手段,应用肝素抗凝治疗脑静脉血栓安全有效。     

急性肠系膜静脉血栓形成8例临床分析

目的探讨急性肠系膜静脉血栓形成(AMVT)的诊治要点。方法回顾性分析我院1995年7月至2003年6月经手术确诊的8例AMVT的临床特点及诊治情况。结果8例术前均以急腹症就诊,疑诊AMVT2例,8例均手术后确诊。1例为肠系膜上静脉主干血栓形成,全小肠坏死,术后2d死亡。余7例部分肠系膜静脉栓塞及肠坏死,6例治愈,1例并发双下肢深静脉血栓形成。5例明确病因。结论AMVT大多数以急腹症就诊,早期腹痛明显而体征轻微是其临床特点,临床诊断较困难。对有急性弥漫性腹膜炎、可疑肠坏死和血流动力学不稳的患者应立即手术治疗。     

肠系膜静脉血栓形成4例分析

目的探讨肠系膜静脉血栓形成(MVT)的诊断及治疗.方法总结4例MVT患者的诊治经验,从病因、诊断和治疗等方面进行分析.结果4例患者均以腹痛起病,症状与体征不符,术前误诊率达100%,均经手术治疗,3例治愈,1例死亡.结论该病少见,术前诊断困难,多经手术确诊.提高对该病的认识,选择B超、CT等较敏感的检查,对诊断有积极意义.早期切除坏死肠管及静脉阻塞的肠系膜,术中术后抗凝、溶栓治疗是防止复发、降低死亡率的重要措施.     

急性肠系膜上动脉及下动脉栓塞合并急性脾梗死1例

<正>急性肠系膜缺血(acute mesenteric ischemia, AMI)疾病起病突然、病情危重且变化迅速，其中急性肠系膜动脉栓塞(EAMI)往往继发于心房颤动、心脏瓣膜疾病血栓形成。早期诊断及干预是影响其预后的重要因素。但临床上早期诊断困难，肠管坏死多见，治疗缺乏统一标准，预后极差。本文分析报道急性肠系膜上动脉及下动脉栓塞合并急性脾梗死，后经急诊静脉溶栓、介入取栓及导管内溶栓、抗凝等综合治愈出院1例，为EAMI的临床诊治提供参考。     

老年急性胰腺炎53例临床分析

目的探讨老年急性胰腺炎的临床特征及诊治方法。方法回顾性分析53例老年急性胰腺炎患者的临床资料。结果老年急性胰腺炎多合并有基础疾病,诱发因素主要为胆系疾病39例,占73.6%,临床主要表现为腹痛、腹胀、发热等。行急诊手术9例,术后6例发生并发症,经对症处理后均好转,死亡3例;行择期手术21例,术后发生并发症10例,经对症处理后均好转;其余23例经非手术保守治疗痊愈。结论老年急性胰腺炎主要病因为胆系疾病,临床表现多种多样,症状不典型,且合并症多,病情重,内科积极治疗有助于改善预后。     

176例肠结核严重并发症的外科手术治疗分析

目的 探讨肠结核严重并发症的外科诊治经验。方法 回顾性收集解放军第三〇九医院2006年5月至2016年5月收治的176例肠结核严重并发症外科手术患者的临床资料,包括并发单一肠梗阻者132例(75.0%)、急性肠穿孔者16例(9.1%)、慢性肠瘘者7例(4.0%)、肠出血者4例(2.3%),以及肠梗阻+肠穿孔6例(3.4%)、肠梗阻+肠瘘者11例(6.3%)。分析所有患者的手术时机、手术方式、术后并发症及治疗、随访结果等。结果 本组行急诊手术者31例(17.6%);96例(54.5%)完全性肠梗阻患者经保守治疗48~72h后,梗阻症状无改善而行手术治疗;31例(17.6%)不完全性肠梗阻、18例(10.2%)慢性肠瘘患者经规范抗结核治疗效果不佳后行手术治疗。132例并发单一肠梗阻患者均行肠粘连松解及部分小肠切除术,4例因腹腔广泛致密粘连中途放弃手术,11例行部分小肠切除术患者先行小肠造口,二期再行还纳手术。40例并发肠梗阻+急性肠穿孔或慢性肠瘘的患者均行部分肠切除术,17例有肠梗阻者同时行肠粘连松解术,12例行小肠造口术。4例肠出血患者均行部分肠切除,均同时行小肠造口术。176例手术患者中,20例(11.4%)出现早期手术并发症,其中肠瘘2例、肠出血1例、腹腔或盆腔脓肿3例、肺部感染4例、下肢深静脉血栓2例、伤口感染8例,均通过抗感染、抗凝及换药等保守治疗后痊愈。术后死亡2例,死亡率为1.1%(2/176)。8例失访,166例随访12~18个月,平均随访时间(15.8±4.2)个月,随访率为95.4%(166/174)。术后3个月内肠结核临床症状完全缓解143例(86.1%,143/166),因再次肠梗阻、肠穿孔或肠瘘行二次手术8例(4.8%,8/166),随访期间出现腹痛、腹胀、腹泻、便秘症状长期不能缓解15例(9.0%,15/166)。结论 肠结核一旦出现严重并发症应及时手术治疗,准确的手术时机、合理的手术方式及规范的抗结核药物治疗是保证肠结核严重并发症救治成功的关键。     

肠系膜静脉血栓31例

目的:总结肠系膜静脉血栓形成(mesenteric venous thrombosis,MVT)的临床经验,探讨MVT形成的临床表现、诊断和治疗.方法:回顾性分析河北联合大学附属医院31例MVT住院患者的临床资料,调查其危险因素、既往血栓史、主诉和查体、实验室检查、放射学检查、治疗及预后.结果:1990-2010共收治MVT患者31例;男性24例,女性7例;平均年龄55.6岁;主要的临床表现为腹痛(100%)、呕吐(77.4%,24/31)、腹胀(64.5%,20/31)、便秘(41.9%,13/31);肝脏疾病、既往手术史、糖尿病和恶性肿瘤是MVT的主要高危因素;增强CT扫描是首选检查手段.7例患者接受单纯抗凝治疗,24例患者接受手术治疗;4例患者死亡.抗凝和手术治疗是MVT的主要治疗手段.结论:MVT临床表现无特异性;早期诊断,及时治疗是改善预后的关键.     

43例腹腔结核并发肠穿孔患者的外科治疗效果分析

目的 分析外科治疗腹腔结核致肠穿孔患者的临床情况。方法 收集河北省胸科医院2008—2016年收治的43例经手术病理确诊的腹腔结核伴肠穿孔患者,所有患者经胸部X线摄影或CT扫描检查均为可疑肺结核。描述性总结分析其术前临床表现、实验室检测及各项检查、术中探查及手术方式、术后治疗及并发症、治疗结果、随访结果等临床资料。结果 43例患者术后病理证实均存在腹腔结核,其中32例非急诊患者临床诊断明确者18例,11例急诊患者术前均未明确诊断;术中探查均存在肠穿孔,其中术前考虑单纯肠梗阻3例、肠梗阻伴肠穿孔30例(8例急诊和22例非急诊患者术前经诊断性穿刺诊断肠穿孔)、单纯肠穿孔10例。40例(93.0%)因病变范围广泛、感染严重行Ⅰ期肠切除+造瘘术,其中12例切口感染患者经切口换药、引流后治愈;8例发生肠瘘患者除2例(保守治疗、二次手术各1例,年龄均>65岁)因多脏器功能衰竭死亡外,余6例经治疗后预后良好;2例发生肠梗阻患者1例行二次手术、1例保守治疗后治愈;余18例患者造瘘术后恢复良好。2例(回盲部肿物伴穿孔1例,腹腔感染较轻1例)行回盲部切除+回结肠吻合术;1例因近回盲部出现回肠局部单一穿孔,且同时并发腹腔淋巴结结核、局部淋巴结节和穿孔部位回肠粘连,但腹腔感染较轻的患者行回肠部分切除+肠吻合术,术后无严重并发症。抗结核治疗12个月后均治愈停药。37例患者停药后随访18~24个月,4例患者失访,随访期内16例患者有间断轻微腹痛症状,其他患者一般情况均良好。结论 腹腔结核伴肠穿孔是严重的消化道结核并发症,规范的抗结核药物治疗是基础,而外科手术是有效治疗的首选方式,治疗效果良好。     

Primary mesenteric venous thrombosis: a study from western India.

INTRODUCTION: The prevalence and clinical spectrum of mesenteric venous thrombosis (MVT) in India is largely unknown. METHODS: We retrospectively re-viewed the case records of patients with primary mesenteric venous thrombosis seen over a 10-year period and retrieved information on clinical picture, underlying hypercoagulable states and outcome. RESULTS: The 28 cases (mean age 41.2 [SD 10.2] years; 19 male) included 13 with acute MVT, 10 with subacute MVT and 5 with chronic MVT. Ten patients had past thromboembolic events (multiple events in five); four patients had isolated superior mesenteric vein involvement and 14 had multiple vessel involvement. Hypercoagulable state was identified in 17 patients, with multiple etiologies in 7 patients. Pre-operative diagnosis was made in all patients. Ten patients needed surgical management; the rest were managed medically initially, but 2 required surgery on follow up. Seven patients died during a follow up of up to 10 years, with in-hospital mortality during index admission in six. CONCLUSIONS: Most of the patients with MVT have multiple intra-abdominal vessel involvement and underlying hypercoagulable state. The policy of early treatment with anticoagulation in all and surgical treatment as per need, achieves low mortality.     

胆道术后假性动脉瘤破裂出血14例诊治分析

目的探讨胆道术后假性动脉瘤破裂出血的诊治方法及预防。方法回顾性分析解放军总医院肝胆外科2002年1月至2012年3月收治的14例胆道术后假性动脉瘤破裂出血患者的临床资料。14例患者猝死4例,其余10例按不同诊断治疗方法分为3组：出血后保守治疗组2例;出血后立即行剖腹探查、止血术组5例;出血后立即行选择性数字减影血管造影（DSA）检查及介入栓塞（TAE）治疗组3例。对其诊治要点及预防措施进行探讨。结果本组病例死亡6例,治愈8例。保守治疗2例均失败（100%）,后均接受DSA检查及TAE治疗,1例死亡;剖腹探查、止血5例,2例确诊（40%）后治愈（40%）,余3例术后又接受DSA检查及TAE治疗,1例死亡;出血后立即行选择性DSA检查及TAE治疗组3例,确诊3例（100%）,治愈3例（100%）。所有病例共行选择性DSA检查8例,确诊8例（100%）,经TAE治疗9次（8例）,有效8次（89%）,治愈6例（75%）;其中经2次TAE治疗1例,死亡2例。死亡病例中4例猝死,1例为2次TAE治疗后肝功能衰竭死亡,另1例为剖腹转栓塞止血后多脏器功能衰竭死亡。结论胆道术后假性动脉瘤破裂出血应早期诊断、早期治疗。选择性DSA检查是本病的首选诊断方法。TAE治疗应作为本病的首选治疗方法。胆道术后假性动脉瘤的形成与手术操作有关,应重在预防。     

Clinical outcome of catheter fragmentation and aspiration therapy in patients with acute pulmonary embolism]

The clinical usefulness of catheter fragmentation and aspiration therapy was studied in 8 patients with acute pulmonary embolism who received thrombolytic therapy using urokinase or tissue-type plasminogen activator (t-PA) (thrombolysis group) and 8 patients who underwent catheter fragmentation and aspiration therapy using a percutaneous transluminal coronary angioplasty (PTCA) guide catheter (catheter group). The patients were selected from 20 patients with a definite diagnosis of acute pulmonary embolism based on pulmonary arteriography and nuclear imaging. Urokinase (48 x 10(4) to 96 x 10(4) unit/day) or t-PA (12 x 10(6) unit/day) was administered intravenously for mean 4 days in the thrombolysis group. Pulmonary artery pressure was first measured using a Swan-Ganz catheter via the jugular vein or the femoral vein in the catheter group. Then, a PTCA guide catheter was advanced into the pulmonary artery, and the thrombus was disrupted repeatedly using a Radifocus wire, followed by manual aspiration. Subsequent treatment consisted of intravenous infusion of heparin (10,000 to 15,000 unit/day) and urokinase (24 x 10(4) to 48 x 10(4) unit/day) for mean 6 days. Partial revascularization was achieved in all patients in both groups. Five patients in the thrombolysis group died within 1 month due to respiratory failure, re-embolization, and/or hemorrhagic complications. One patient in the catheter group died of hemorrhagic shock. Pulmonary artery systolic pressure in the catheter group was significantly reduced from 47.4 to 26.5 mmHg (p < 0.01). Catheter treatment of acute pulmonary embolism associated with acute circulatory failure such as shock can lead to rapid hemodynamic improvement. In contrast, thrombolysis is an effective treatment, but bleeding problems are common and caution is required. Catheter fragmentation and aspiration therapy is effective for acute pulmonary embolism, is minimally invasive, and should be considered the treatment of first choice.     

Mesenteric venous thrombosis in inflammatory bowel disease

Mesenteric venous thrombosis (MVT) is a rare but potentially catastrophic clinical complication, which may lead to ischemia or infarction of the intestine and/or the emergence of portal hypertension. An association between inflammatory bowel disease (IBD) and MVT has previously been described, but clinical factors that may contribute to this complication in the setting of IBD are not well characterized. Diagnosis of MVT in IBD is difficult, as patients frequently present with nonspecific abdominal discomfort, which may delay diagnosis and initiation of treatment. We report 6 of 545 IBD patients at our center (1.1%) that developed MVT, and describe presentation, diagnostic approaches, treatment options, underlying contributing factors, and outcome. The diagnosis was determined with abdominal computed tomography (CT) in 5 of 6 cases. Clinical factors, which were thought to contribute to MVT, included underlying hypercoagulability, low-flow state, uncontrolled inflammation, perioperative time period, and prior surgical manipulation of the portal vein following orthotopic liver transplantation. There were no deaths as a result of MVT, although 1 patient developed severe portal hypertension and another experienced intestinal infarction requiring extensive resection. We conclude that MVT is an important clinical consideration in IBD patients, specifically during the perioperative setting, and diagnosis is facilitated with the use of CT scan.