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目的　探讨非手术治疗急性MVT的优势以及治疗该病的最佳方案。方法　回顾 1995～ 2 0 0 2年间收治的 17例经非手术治疗的急性肠系膜静脉血栓形成 (mesentericvenousthrombosis,MVT)的诊断、治疗及预后 ,对急性MVT诊断一经确立后 ,立即采用抗凝溶栓等保守治疗 ,并严密观察 ,如有急性腹膜炎发生则随时中转手术。结果　病人全部治愈 ,治疗过程中无中转手术发生。平均住院天数为 ( 11 9± 3 7)天。2年生存率为 88 2 %。结论　早期诊断及抗凝溶栓治疗直接影响到该病的预后 ;在肠缺血尚未导致透壁性肠坏死、肠穿孔时 ,非手术治疗完全可行。     

肠系膜上静脉血栓形成32例诊疗体会

目的探讨肠系膜上静脉血栓形成(MVT)的诊断与治疗。方法回顾性分析我院2000年~2004年收治的32例MVT的临床资料。结果本组行手术治疗14例。其中,有2例行二次手术治疗。治愈29例,死亡3例。结论提高对本病的认识,及时应用螺旋CT三维重建等检查方法早期诊断及围术期采取恰当的溶栓、抗凝治疗是防止复发、降低病死率的重要措施。手术治疗仅适用于出现腹膜炎等肠坏死征象的病例。强调彻底扩大切除坏死肠管及相应系膜。     

急性肠系膜静脉血栓形成27例诊治经验

目的 总结急性肠系膜静脉血栓形成(MVT)的诊治经验.方法 回顾性研究1983年至2007年7月收治的27例急性MVT的临床资料.结果 27例患者病程1～14 d,平均6.1 d.既往有门静脉高压症、下肢静脉血栓、肠系膜静脉血栓等病史或合并其他高凝状态者18例(66.7%).本组超声、CT、血管造影及外周血D-二聚体(D-Dimer)水平对急性MVT的诊断敏感性分别为70.6%(12/17)、75.0%(6/8)、100%(6/6)、100%(6/6).16例腹腔穿刺抽出血性腹水者均已继发肠管坏死.11例行溶栓、抗凝治疗,4例有效(36.4%).22例接受手术治疗,均行坏死肠管切除术,其中3例术中行经肠系膜上静脉血栓取出术.3例术后并发下肢深静脉血栓,1例并发心肌梗死,3例继发短肠综合征.4例手术后一周内急性MVT复发.8例在发病后1个月内死亡,其中7例为手术后死亡.19例存活的患者均接受了抗凝治疗.15例得到随访,其中7例长期服用抗凝药物.结论 对于急性MVT,血D-Dimer水平的检测以及针对肠系膜血管的影像学检查是尽早确诊的关键.对无活动性出血和腹膜炎的病例,首选考虑进行抗凝溶栓治疗.对已继发肠管坏死者应进行手术.     

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目的 探讨肝硬变病人门静脉系统血栓形成的诊断和治疗。方法 对17例肝硬变门静脉系统血栓形成病人的诊断和治疗进行回顾性分析。结果 本组肝硬变病人断流和（或）分流术后门静脉系统血栓形成发生率为18．68％（17／91）。彩色多普勒超声检查确诊7例,CT确诊2例,肠系膜血管造影确诊2例,开腹探查确诊6例。9例经溶栓治疗临床治愈,8例行肠切除Fogarty管取栓术,死亡1例。结论 对于肝硬变特别是断流和（或）分流术后病人出现腹胀、腹痛、腹泻者应注意门静脉系统血栓形成的可能;彩色多普勒超声和动态多时相CT有助于早期诊断;早期诊断和积极溶栓治疗有助于防止肠管坏死的发生;出现肠坏死、腹膜炎者应切除坏死肠管及有血栓的肠系膜,同时继续抗凝祛聚治疗。     

急性肠系膜上静脉血栓形成的诊治体会(附14例报告)

目的探讨急性肠系膜上静脉血栓形成(MVT)的诊疗方法。方法回顾性分析我们2000年1月~2005年12月收治的14例MVT的临床资料。本组行肠切除及Fogarty导管取栓术8例,行抗凝、溶栓治疗6例。结果本组治愈13例,死亡1例。结论超声、CT和MRV诊断价值较大。及早诊断,行抗凝、溶栓治疗可防止肠坏死的发生。对出现肠坏死、腹膜炎者,切除坏死肠管及系膜,同时积极抗凝治疗能降低死亡率和复发率。尿激酶联合巴曲酶治疗MVT是有效和安全的。     

脾切除术后门静脉系血栓形成的临床诊治

目的探讨脾切除术后门静脉血栓(portal vein thrombosis,PVT)和肠系膜静脉血栓(mesenteric venous thrombosis,MVT)形成的成因及诊治策略。方法回顾分析2000年以来收治脾切除术后门静脉及肠系膜静脉血栓形成12例患者的临床资料。结果全组病例脾切除后静脉系血栓的发生率为4.3%(12/280),其中PVT发生率为3.2%(9/280),MVT发生率为1.1%(3/280)。PVT和MVT患者均出现白细胞增多,血小板计数升高,D-D二聚体检测阳性和凝血功能异常。彩色多普勒超声、增强CT检查及MRA门静脉成像确诊9例,同时行肠系膜上动脉血管造影确诊1例,因急性肠梗阻剖腹探查术确诊2例。9例经积极的全身抗凝、祛聚、溶栓治疗1～2周好转出院。2例MVT因肠坏死行小肠切除肠吻合术,术后全身抗凝、祛聚治疗,痊愈出院。1例PVT血栓急性发展至肝内门静脉,死于肝功能衰竭。结论脾切除后门静脉系统血栓形成与多种因素有关。早期诊断与及时抗凝治疗对预后有重要影响。非手术治疗效果不佳应及时手术治疗。     

肠系膜上静脉血栓形成10例诊治分析

目的分析和探讨肠系膜上静脉血栓（MVT）形成的诊断和治疗方法。方法回顾分析我院1999年至2007年收治的10例MVT患者。结果继发性MVT患者占发病的绝大多数（70％,7／10例）,早期症状不典型,主要为腹胀、腹痛、恶心、呕吐、腹泻、便血,误诊率60％（6／10）。9例手术患者均出现小肠坏死,切除坏死肠段和术后的抗凝是治疗关键。对比增强的CT是该病的首选检查方法。结论MVT是少见急腹症,容易导致诊治延误,对比增强CT是首选检查,有助于早期诊断。手术和抗凝是治疗成功的关键;早期在未出现腹膜炎之前可采用保守的溶栓治疗。     

急性肠系膜上静脉血栓形成18例诊治体会

目的总结急性肠系膜上静脉血栓形成(superiormesentericvenousthrombosis,SMVT)的诊治经验。方法18例急性SMVT患者,6例行抗凝、溶栓治疗(其中1例中转手术),另12例行手术治疗,切除坏死肠管及含有静脉血栓的全部肠系膜。结果6例抗凝、溶栓治疗患者中顺利溶栓、症状体征消失者5例(83.3%);另1例患者于非手术治疗17h后出现明显的腹膜炎体征而中转手术。13例开腹探查的患者中治愈9例(69.2%),死亡4例(30.8%),死于小肠广泛坏死短肠综合征、多系统器官功能衰竭各2例。结论早期诊断及抗凝、溶栓治疗使非手术疗法成为首选,但对于已出现腹膜炎、穿孔等肠缺血坏死征象的患者则应考虑手术治疗。     

肠系膜静脉血栓的介入治疗

目的探讨经肠系膜上动脉灌注罂粟碱和经皮经肝肠系膜静脉取栓和／或溶栓联合治疗肠系膜静脉血栓（MVT）的价值。方法回顾分析北大三院经介入诊治的9例MVT。9例患者均行血管造影检查和超声检查，其中5例行CT检查，2例行MR检查。患者从就诊到明确诊断接受介入治疗的时间间隔为15～168小时。明确诊断MVT后即经外周静脉给予肝素抗凝治疗；9例MVT均行经肠系膜动脉灌注罂粟碱治疗，其中8例同时行经皮经肝门静脉、肠系膜上静脉取栓和溶栓治疗。2例怀疑肠坏死介入治疗后行外科肠切除术。结果本组9例MVT中2例血栓局限在肠系膜上静脉内；7例血栓延及门静脉或脾静脉。9例患者7例治愈；1例不明原因猝死；1例因门脉高压行门腔静脉分流术后肝功衰竭死亡。结论经肠系膜动脉灌注罂粟碱联合经皮经肝门静脉、肠系膜静脉取栓和／或溶栓是治疗MVT的有效方法。     

急性肠系膜静脉血栓形成的诊治

目的: 探讨急性肠系膜静脉血栓形成（AMVT）的诊治方法。方法:回顾性分析1990年10月—2004年8月期间收治的22例急性MVT的临床资料，其中16例术前经CT或超声检查确诊，6例于剖腹探查术中确诊。全组有16例经手术治疗，其中4例采用美蓝判断肠坏死的范围；有6例采用介入治疗，其中4例采用经肠系膜上动脉溶栓治疗，2例采用经皮经肝途径在肠系膜静脉内行血栓清除术。结果:手术组4例死亡，3例死于脓毒性休克，1例死于多器官功能衰竭。介入组6例均治疗成功，血栓清除满意。结论:急性MVT的诊治关键在于早期诊断，CT检查是准确的方法。对于已经有肠坏死的患者，手术切除是首选的方法，术中美蓝确定坏死肠管范围有一定价值。对于无坏死型MVT，介入治疗是一种有价值的方法。     

Thrombolysis via an Operatively Placed Mesenteric Catheter for Portal and Superior Mesenteric Vein Thrombosis: Report of a Case

Mesenteric venous thrombosis (MVT) is a catastrophic form of mesenteric vascular occlusion. In the absence of peritoneal signs, anticoagulation therapy should be started immediately. For selected patients, thrombolysis through the superior mesenteric artery (SMA), jugular vein, or portal vein via a transhepatic route might be successful; however, exploratory laparotomy is mandatory when peritoneal signs develop. We report a case of acute MVT associated with protein C and S deficiency, treated successfully by limited bowel resection and simultaneous thrombolytic infusion, given via an operatively placed mesenteric vein catheter.     

Deciphering mesenteric venous thrombosis: imaging and treatment

The principal cause of a high mortality rate in mesenteric vein thrombosis (MVT) is a delay in diagnosis. Recent data indicate that the mortality rate is decreasing owing to earlier diagnosis and anticoagulation. The authors examined the treatment profile of MVT to see how the increased use of imaging and early anticoagulation has impacted this process. They retrospectively analyzed the treatment paradigm with acute MVT at one institution over a 10-year period. Twenty-three patients were identified. Data were analyzed using chi-squares and Student's t tests. Twenty-three patients (11 men and 12 women with an average age of 51.74 +/-14.8 years) were identified with acute MVT between the years of 1993 and 2003. Five patients had splenic vein thrombosis, 17 had superior mesenteric vein thrombosis, 1 had inferior mesenteric vein thrombosis, and 12 had portal vein thrombosis. Nine patients had combination mesenteric vein segment thrombosis. Thrombolytics were utilized in a total of 6 patients. Four of the 6 patients in whom lytics were utilized had combined mesenteric vein thrombosis; however, these 4 patients did not require surgical intervention. There was no significant difference in length of hospital stay between patients taking lytics versus patients treated with traditional anticoagulation with heparin (p = 0.291). A hypercoagulable state was identified in 66.7% of the patients. Four patients required surgical intervention. The overall mortality rate was 8.7% (2 of 23). The use of thrombolytics was associated with a significant mortality (p = 0.04). The use of antibiotics made no difference in mortality (p = 0.235), nor did antibiotic use influence length of hospitalization (p = 0.192). MVT is relatively rare, and often the delay in diagnosis increases the mortality rate. In the majority of cases prompt anticoagulation will preserve bowel viability and decrease mortality and morbidity rates. The majority of patients do not need surgery. There is a marked increase in mortality rate when these patients progress to surgical intervention. An increased awareness and early diagnosis has led to decreased morbidity and mortality rates.     

Acute mesenteric venous thrombosis: case for nonoperative management

OBJECTIVE: Initial treatment in the management of acute mesenteric vein thrombosis (MVT) is controversial. Some authors have proposed a surgical approach, whereas others have advocated medical therapy (anticoagulation). In this study, we analyzed and compared the results obtained with surgical and medical treatment to determine the best initial management for this disease. METHODS: We retrospectively reviewed the records of patients treated for MVT in a secondary care surgical department from January 1987 to December 1999. Before January 1995, our departmental policy was to perform surgery in patients with suspected MVT. Since January 1995, we have preferred a medical approach when achievable. Each patient in this study was assessed for diagnosis, initial management (laparotomy or anticoagulation), morbidity, mortality, duration of hospitalization, the need for secondary operation, portal hypertension, and survival rates. RESULTS: Twenty-six patients were treated, 14 before January 1995 (group 1) and 12 since January 1995 (group 2). Morbidity, mortality, secondary operation, portal hypertension, and 2-year survival rates were 34.6%, 19.2%, 15.3%, 19.2%, and 76.9%, respectively. No statistical difference was observed between the two groups. The mean duration of hospitalization was 51.6 days in group 1 and 23.2 days in group 2 (P < .05). Among the 12 patients treated by means of laparotomy with bowel resection, 10 patients (83%) had mucosal necrosis without transmural necrosis at pathologic study. CONCLUSION: Nonoperative management for acute MVT is feasible when the initial diagnosis with a computed tomography scan is certain and when the bowel infarction has not led to transmural necrosis and bowel perforation. The morbidity, mortality, and survival rates are similar in cases of surgical and nonoperative management. The length of hospital stay is shorter when patients are treated with a nonoperative approach. A nonoperative approach, when indicated, avoids the resection of macroscopically infarcted small bowel (without transmural necrosis) in cases that are potentially reversible with anticoagulation alone.     

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??Choice of treatment option for acute mesenteric venous thrombosis ZHANG Ji-wei. Department of Vascular Surgery??Renji Hospital??Shanghai Jiao Tong University School of Medicine??Shanghai 200127??China
Abstract Due to the hidden symptoms of mesenteric venous thrombosis (MVT)??it is easy to delay the diagnosis resulting in high mortality. Careful inquiry of thrombosis risk factors combined with imaging examination, especially the vascular Doppler and CTA??can help to diagnose early. After diagnosis of MVT??systemic anticoagulant therapy should be administered immediately. For patients with peritonitis and intestinal necrosis??emergency resection of necrotic bowel should be performed. If anticoagulant therapy is invalid??or even lead to exacerbation of symptoms??thrombolytic treatment of thrombosis site should be chosen by vascular intervention technique if no contraindication exists??so as to promote the recovery of mesenteric and portal venous circulation.     

肠系膜静脉血栓形成七例临床分析

为探讨肠系膜静脉血栓形成的临床诊治经验，作者从病理生理、病因、致病因素、临床表现、诊断及治疗等方面对肠系膜静脉血栓形成进行了探讨。作者１９８４年至１９９６年收治了肠系膜静脉血栓形成患者７例，全部经手术治疗并经病理证实。本组７例患者经手术及抗凝治疗，其中５例治愈，２例死亡。作者认为此病大多数以急腹症就诊，术前要做出正确诊断有一定难度。对可疑病例必须进行严密观察及适时开腹探查。为降低死亡率，必须彻底切除包括外观正常但含有血栓系膜的肠袢，此外应早期、足量给予抗凝治疗。     

Mesenteric and portal vein thrombosis: treated with early initiation of anticoagulation.

OBJECTIVE: Superior mesenteric vein thrombosis (SMVT) is generally difficult to diagnose and can be fatal. Mesenteric and portal vein thrombosis is rare and can be presented as more serious conditions than that of SMVT. We report patients with combined SMVT and portal vein thrombosis (PVT) who were treated successfully with early initiation of anticoagulation. METHODS: The medical records of six patients (five male, one female) who presented with combined SMVT and PVT in our institute between January 1994 and September 2003 were reviewed retrospectively. All of the patients were treated with early initiation of anticoagulation using unfractionated heparin or low molecular weight heparin. RESULTS: The mean hospital stay was 31 days and the mean follow-up period was 32 months. Three patients had an antithrombin III deficiency. The most common symptom was diffuse abdominal pain and signs included abdominal distension and tenderness. During the follow-up period, there were two patients who developed stricture of the small bowel necessitating resection and anastomosis of the small bowel. There was no case of peritonitis due to bowel necrosis or mortality. CONCLUSION: The early initiation of anticoagulation in patients of SMVT combined with PVT could minimise the serious complication such as peritonitis due to bowel necrosis required immediate exploratory laparotomy.     

Mesenteric vein thrombosis following impregnation via in vitro fertilization-embryo transfer

Pregnancy is an acquired hypercoagulable state. Most patients with thrombosis that develops during pregnancy present with deep vein leg thrombosis and/or pulmonary embolism, whereas the development of mesenteric vein thrombosis(MVT) in pregnant patients is rare. We report a case of MVT in a 34-year-old woman who had achieved pregnancy via in vitro fertilization-embryo transfer(IVFET). At 7 wk of gestation, the patient was referred to us due to abdominal pain accompanied by vomiting and hematochezia, and she was diagnosed with superior MVT. Following resection of the gangrenous portion of the small intestine, anticoagulation therapy with unfractionated heparin and thrombolysis therapy via a catheter placed in the superior mesenteric artery were performed, and the patient underwent an artificial abortion. Oral estrogen had been administered for hormone replacement as part of the IVF-ET procedure, and additional precipitating factors related to thrombosis were not found. Pregnancy itself, in addition to the administered estrogen, may have caused MVT in this case. We believe that MVT should be included in the differential diagnosis of a pregnant patient who presents with an acute abdomen.