Revascularization in treatment of mesenteric infarction.

This study compares results of primary revascularization with primary intestinal resection in treatment of acute mesenteric artery occlusion in 48 surgical patients. All cases were verified by surgical exploration, angiography or autopsy. Fifteen occlusions were caused by mesenteric thrombosis and 33 by superior mesenteric artery embolization. Primary revascularization was done in 6 of 15 patients with arteriosclerotic mesenteric thrombosis. Total bowel salvage was achieved in 4 patients but no patient with mesenteric thrombosis treated by any method survived long term. Primary embolectomy was done in 11 patients with superior mesenteric artery embolization. Ttoal bowel salvage was achieved in 8 patients. Three of 11 patients died. Primary exploration and/or resection was done in 11 patients; 9 died. All 11 umoperated patients died. A continuation of attempts at mesenteric revascularization is advocated.     

The acute mesenteric ischemia - not understood or incurable?

PURPOSE: Despite surgical research and progress, the high mortality of acute intestinal ischemia seems to be improved insignificantly over the past fifty years. In this study we analyzed the specific diagnostic and therapeutic problems of the disease in order to improve further management of acute mesenteric ischemia. Methods: From 1979 until 2000 64 patients (female 31, male 33) with a mean age of 64 (30-89) years underwent operation for primary intestinal ischemia at our institution. All medical and surgical records and imaging studies were reviewed retrospectively. Follow up consisted of clinical examination and duplex sonography. RESULTS: Only in 26 patients (41 %) a preoperative diagnostic work-up including angiography 12 and CT 14 was performed, whereas in 42 cases the intestinal ischemia was diagnosed during surgical exploration. Intestine malperfusion was caused primarily by venous thrombosis in 9 cases (14 %) and by arterial occlusive disease in 55 cases (86 %). Arterial disorders consisted of arterial thrombosis in 19 cases (30 %), arterial embolism in 18 cases (28 %), aortic or mesenteric artery dissection in 10 cases (15 %), non occlusive disease (NOD) in 5 cases (8 %), trauma 3 cases (5 %). Five different therapeutic strategies were applied: group I: Intestinal resection: 24 patients, anastomotic insufficiency 5 (39 %), mortality 11 (46 %), group II: intestinal artery revascularization: 5 patients, secondary patency rate 80 %, mortality 40 %, GROUP III: Intestinal artery revacularization and perfusion with Ringer's solution: 11 patients, mortality 8 (73 %), group IV intestinal artery revascularization and intestinal resection: 3 patients, mortality 100 %, group V intestinal artery revascularization and perfusion and intestinal resection: 3 patients, mortality 33 %. A second look operation was performed in 29 cases (40 %) and displayed malperfusion in 72 %. Only 21 of 64 patients survived the acute intestinal ischemia (in hospital mortality was 67 %). Delayed diagnostic and operation caused higher mortality (interval 10 hours: mortality 59 %, interval 37 hours mortality; 71 %, p = 0,06). Follow up after 61 (4-72) months of 21 patients (100 %) could be achieved. Ten patients (48 %) had meanwhile died, 5 patients (50) % as consequence of mesenteric ischemia, the others of unrelated reasons. Eleven patients are still alive without clinical signs of intestinal ischemia. CONCLUSIONS: Early diagnosis before hospitalisation and in-hospital (arteriography) and operation are essential to improve the outcome of patients with acute intestinal ischemia. To avoid short bowel syndrome bowel resection should be combined with mesenteric revascularization. Resection of malperfused bowel should be done cautiously and should be followed automatically by second look operations. Special expertise and good team work of visceral and vascular surgeons are required to achieve better therapeutic results.     

Mesenteric venous thrombosis

Sixteen patients with mesenteric venous thrombosis were reviewed retrospectively during a period from 1983 to 1987. Twelve patients had progressive abdominal pain, three had gastrointestinal bleeding, and one had general malaise. Seven of these 16 patients had previous deep-vein thrombosis. After negative routine gastrointestinal and hepatobiliary evaluation, 11 patients underwent an infusion computerized tomographic scan. Of these, 10 had superior mesenteric vein thrombosis; three of these 10 patients had portal vein thrombosis. Selective arteriography was done in two patients because of gastrointestinal bleeding, and a diagnosis of mesenteric vein thrombosis was made on the venous phase of the examination. The remaining four patients developed acute abdominal symptoms requiring surgical exploration, at which time mesenteric venous thrombosis was discovered. An identifiable coagulopathy was detected in nine patients (protein C deficiency in six, protein S deficiency in two, and factor IX deficiency treated with factor IX concentrate in one). No case of congenital antithrombin-III deficiency was identified. Six of these nine patients had a past history of deep venous thrombosis. Of five patients who underwent surgical exploration, all required bowel resection. In follow-up, two patients died of intestinal necrosis and a third died of associated pancreatic cancer. Thirteen patients were discharged from the hospital. Treatment of coagulopathy was by heparin in three patients and sodium warfarin (Coumadin) in four patients. Long-term anticoagulation was not instituted because of gastrointestinal bleeding in three and cirrhosis in three patients. Mesenteric venous thrombosis can occur without gangrenous bowel. Diagnosis should be suspected when acute abdominal symptoms develop in patients with prior thrombotic episodes and a coagulopathy.(ABSTRACT TRUNCATED AT 250 WORDS)     

急性肠系膜血管闭塞的诊治经验（附16例报告）

目的　探讨急性肠系膜血管闭塞 (AMVO)的早期诊断和治疗。方法　 8例急性肠系膜动脉栓塞 (MAE)确诊 5例 ,误诊 3例。保守治疗 1例 ,介入溶栓 1例 ,肠切除 4例 ,取栓后肠切除 1例 ;另 1例大部小肠严重缺血 ,经二次手术探查 ,避免了肠切除和短肠综合征。 8例急性肠系膜静脉血栓形成 (MVT)确诊 4例 ,疑诊 4例 ;保守治疗 2例 ,肠切除 2例 ,取栓后肠切除 4例。结果　 8例MAE治愈 5例 ,死亡 3例 ;8例MVT全部治愈。结论　对AMVO保持警惕 ,早期确诊是提高疗效的关键。     

急性肠系膜缺血性疾病的损伤控制性处理

目的 探讨损伤控制性外科（DCS）理念在治疗急性肠系膜缺血性疾病（AMI）中的应用价值.方法 回顾性分析2001年5月至2009年3月间南京军区总医院解放军普通外科研究所应用DCS理念指导救治15例急性肠系膜缺血性疾病患者（11例为肠系膜上静脉血栓,4例为肠系膜上动脉血栓或栓塞）的临床资料.整个治疗过程遵循迅速切除坏死肠管、不强求恢复肠道连续性、术中取栓、术后ICU复苏并持续溶栓和计划内二期手术重建消化道连续性的阶段性救治策略.结果 10例患者（66.7%）救治成功并获得术后3个月以上的存活期,残留小肠长度120～280（209.0±53.8）cm.均无需肠外营养.5例患者死亡,其中2例死于血栓复发,1例死于术后消化道大出血,1例术中放弃治疗,另1例全小肠切除者术后放弃治疗.结论 DCS治疗理念可以成功救治AMI患者.在处理肠管时,应注意同时进行取栓、溶栓和抗凝治疗.     

Acute mesenteric ischemia: improved results--a retrospective analysis of ninety-two patients

Acute mesenteric ischemia (AMI) is a curable disease if diagnosis and therapy are instituted before irreversible changes have occurred. AMI has been diagnosed with increasing frequency, during the last two decades, yet the mortality rate remains as high as 80% to 95%. Ninety-two patients with AMI were treated at Hadassah University Hospital between 1952 and 1987. Seventy-seven patients were treated surgically: 15 underwent only explorative laparotomy, and 62 underwent bowel resection or revascularization or both. The latter patients were divided into two groups: 17 patients treated surgically between 1952 and 1976, in whom bowel resection and primary anastomosis was the only surgical procedure carried out (group 1), and 45 patients treated in the last decade (group 2), in whom one or more of the following procedures were performed: bowel resection with primary anastomosis (n = 16), revascularization (n = 16), "second-look" (n = 18), and delayed anastomosis (n = 10). The overall mortality rate in 62 surgically treated patients was 40% (82% in group 1 and 24% in group 2) and 21% in 29 patients treated in a combined surgical approach. The reasons for improved results in group 2 patients are discussed, and an algorithm for surgical treatment of patients with AMI of different causes is proposed.     

Acute superior mesenteric vein thrombosis. A retrospective study of 9 patients

AIM OF THE STUDY: To determine diagnostic modalities and both immediate and long-term treatment of superior mesenteric venous thrombosis. PATIENTS AND METHODS: Retrospective study from 1997 to 2004 in two institutions concerning patients with superior mesenteric vein thrombosis. RESULTS: Nine patients (all males, mean age=55 years), were included. Abdominal pain (100%), vomiting (44%), and bowel activity disorders (44%) were the most common symptoms. A personal or familial thrombosis history was present in 67% of patients. A genetic predisposing factor of thrombosis was present in 78% of patients. The diagnosis was established with CT-scan in 8 cases with a mean delay of 8 days. Treatment was exclusively medical in 33% of patients and included surgery in 67%. All operated patients underwent resection for bowel infarction and only one had immediate anastomosis. All enterostomies were subsequently closed. No patient died. CONCLUSION: Diagnosis of superior mesenteric vein thrombosis is frequently delayed and relies on CT-scan with intravenous contrast. Prognosis is globally favourable but depends on early application of anticoagulation therapy. In case of surgery, bowel-sparing resection is indicated and enterostomies are often needed. Genetic disorders predisposing to thrombosis are very frequent, that may indicate prolonged even definitive anticoagulation therapy.     

Contemporary management of acute mesenteric ischemia: Factors associated with survival

PURPOSE: Acute mesenteric ischemia (AMI) is a morbid condition with a difficult diagnosis and a high rate of complications, which is associated with a high mortality rate. For the evaluation of the results of current management and the examination of factors associated with survival, we reviewed our experience. METHODS: The clinical data of all the patients who underwent operation for AMI between January 1, 1990, and December 31, 1999, were retrospectively reviewed, clinical outcome was recorded, and factors associated with survival rate were analyzed. RESULTS: Fifty-eight patients (22 men and 36 women; mean age, 67 years; age range, 35 to 96 years) underwent study. The cause of AMI was embolism in 16 patients (28%), thrombosis in 37 patients (64%), and nonocclusive mesenteric ischemia (NMI) in five patients (8.6%). Abdominal pain was the most frequent presenting symptom (95%). Twenty-five patients (43%) had previous symptoms of chronic mesenteric ischemia. All the patients underwent abdominal exploration, preceded with arteriography in 47 (81%) and with endovascular treatment in eight. Open mesenteric revascularization was performed in 43 patients (bypass grafting, n = 22; thromboembolectomy, n = 19; patch angioplasty, n = 11; endarterectomy, n = 5; reimplantation, n = 2). Thirty-one patients (53%) needed bowel resection at the first operation. Twenty-three patients underwent second-look procedures, 11 patients underwent bowel resections (repeat resection, n = 9), and three patients underwent exploration only. The 30-day mortality rate was 32%. The rate was 31% in patients with embolism, 32% in patients with thrombosis, and 80% in patients with NMI. Multiorgan failure (n = 18 patients) was the most frequent cause of death. The cumulative survival rates at 90 days, at 1 year, and at 3 years were 59%, 43%, and 32%, respectively, which was lower than the rate of a Midwestern white control population (P <.001). Six of the 16 late deaths (38%) occurred because of complications of mesenteric ischemia. Age less than 60 years (P <.003) and bowel resection (P =.03) were associated with improved survival rates. CONCLUSION: The contemporary management of AMI with revascularization with open surgical techniques, resection of nonviable bowel, and liberal use of second-look procedures results in the early survival of two thirds of the patients with embolism and thrombosis. Older patients, those who did not undergo bowel resection, and those with NMI have the highest mortality rates. The long-term survival rate remains dismal. Timely revascularization in patients who are symptomatic with chronic mesenteric ischemia should be considered to decrease the high mortality rate of AMI.     

Acute Occlusive Mesenteric Ischemia: Surgical Management and Outcomes

Acute mesenteric ischemia secondary to arterial occlusion (AMI) remains a highly lethal condition. To examine recent trends in management and associated outcomes, we examined our institutional experience over a recent 10-year period. All patients treated for AMI between January 1990 and January 2000 were identified (76 patients, 77 cases) and their medical records examined. At presentation, 64% demonstrated peritonitis and 30% exhibited hypotension. The interval from symptom onset to treatment exceeded 24 h in 63% of cases. Etiology was mesenteric thrombosis in 44 patients (58%) and embolism in 32 patients (42%). Thirty-five patients (46%) had prior conditions placing them at high risk for the development of AMI including chronic mesenteric ischemia (n = 26) and inadequately anticoagulated chronic atrial fibrillation (n = 9). Surgical management consisted of exploration alone in 16 patients, bowel resection alone in 18 patients, and revascularization in 43 patients, including 28 who required concomitant bowel resection. Overall, intestinal necrosis was present in 81% of cases. Perioperative mortality was 62% and long-term parenteral nutrition (TPN) was required in 31% of survivors. Peritonitis (odds ratio [OR] 9.4, 95% confidence interval [CI] 1.6, 54.0; p = 0.012 and bowel necrosis (OR 10.4, CI 1.9, 56.3; p = 0.007) at presentation were independent predictors of death or survival dependent upon TPN. We conclude that AMI remains a highly lethal condition due in large part to advanced presentation and inadequate recognition and treatment of patients at high risk.     

Mesenteric vascular occlusion resulting in intestinal necrosis in children

PURPOSE: The records of 4 patients who had necrotic bowel secondary to acute mesenteric vascular occlusion affecting various levels of mesenteric vasculature were reviewed to determine the clinical manifestations, diagnostic investigations, predisposing factors, complications, and outcome of mesenteric vascular thrombosis in children. METHODS: The medical records of the patients (3 boys, 1 girl) treated between 1981 and 1996, inclusive, for bowel infarction secondary to mesenteric vascular thrombosis, were reviewed with regard to signs and symptoms, laboratory tests, radiological investigations, surgical findings, histopathologic examinations, and outcome. RESULTS: The ages of the patients ranged between 1 and 14 years with a mean age of 8.2 years. Initial symptoms, present in all patients, were abdominal pain, abdominal distension, and tenderness. Laboratory and radiological findings including abdominal radiographs and abdominal ultrasonography were nondiagnostic. Selective superior mesenteric angiography showed complete obliteration of the superior mesenteric artery with absence of venous return in 1 case. Three patients with massive intestinal necrosis died of multiorgan failure or the complications of short bowel syndrome. Histological examination of the resected intestinal segments showed the typical findings of polyarteritis nodosa in 2 patients. One patient had a previous history of right femoral vein thrombosis, whereas 1 patient had no known underlying disorders predisposing vascular thrombosis. CONCLUSIONS: Mesenteric vascular occlusion is a rare but serious disease leading to death in children. The patients present with similar clinical signs, most frequent and important are acute abdominal pain, vomiting, and distension. Mesenteric vascular occlusion is a rare cause of acute abdomen in childhood, which requires urgent diagnosis and intervention. In suspected mesenteric vascular insufficiency, angiography should be performed followed by intraarterial thrombolytic infusion therapy in selected cases. When intestinal infarction is suspected, immediate surgical resection of compromised bowel is necessary with appropriate postoperative anticoagulation or treatment of any underlying disease.     

急性门静脉系统血栓形成的诊治

目的 探讨急性门静脉系统血栓形成的诊断方法及治疗措施.方法 回顾性分析13例急性门静脉系统血栓形成病例的临床资料. 结果本组13例急性门静脉系统血栓形成患者均由增强CT或MRI/MRA检杏确诊.其中5例患者接受以抗凝和溶栓为主的非手术治疗,2例死亡;8例接受手术治疗(经肠系膜上静脉切开取栓及置管抗凝和溶栓),其中5例术中发现有部分小肠坏死,同时切除坏死肠段,均痊愈出院.结论 外科手术治疗急性门静脉系统血栓形成疗效确切,并发症少.     

Atherosclerotic occlusive disease of the superior mesenteric artery: Late results of reconstructive surgery

Between 1975 and 1988, 103 patients underwent reconstruction of the superior mesenteric artery for atherosclerotic occlusive disease. Patients undergoing revascularization with associated mesenteric infarction were excluded. There were 89 men and 14 women whose mean age was 57.2 years. Six patients were operated on emergently for impending mesenteric infarction; six patients underwent revascularization after intestinal resection for ischemic lesions; 20 patients had typical abdominal angina; 39 patients had nonspecific abdominal symptoms, and 32 patients underwent revascularization of their superior mesenteric artery for asymptomatic lesions. Revascularization of the celiac axis and inferior mesenteric artery was associated in 36 and four cases, respectively. Four patients (4%) died postoperatively. Four early occlusions (4%) were observed. During the follow-up period (mean=69 months), 18 patients died; five patients had recurrent intestinal ischemic symptoms, four of whom died. All surviving patients underwent follow-up duplex scanning, examination, and arterial or venous digitalized angiograms in selected cases. Nine patients (9%) had anatomical abnormalities: two stenoses and seven occlusions. Failure of revascularization of the superior mesenteric artery was observed in patients with severe initial intestinal ischemia. Late complications were not statistically significantly related to the different techniques of revascularization used. Presented at the Annual Meeting of the Société de Chirurgie Vasculaire de Langue Française, June 23–24, 1989, Strasbourg, France.     

Mesenteric vascular problems. A 26-year experience.

Mesenteric vascular problems are infrequent, but may be catastrophic. During a 26-year period, 55 private patients were treated for the following disorders: (1) 12 patients with visceral artery aneurysms, (2) 8 with celiac compression syndrome, (3) 13 with chronic mesenteric ischemia, (4) 12 with acute mesenteric ischemia, and (5) 10 with mesenteric ischemia associated with aortic reconstructions. Splenic artery aneurysms were managed by excision and splenectomy, while celiac and hepatic had excision with graft replacement. Patients with celiac compression syndrome underwent lysis of the celiac artery. Two patients had compression of both celiac and superior mesenteric artery (SMA). One patient required vascular reconstruction of both arteries for residual stenoses. Patients having chronic mesenteric ischemia were treated with bypass grafts, with one death (7.7% mortality) and good long-term results. Those with acute mesenteric ischemia were treated by SMA embolectomy, bowel resection, or both, with a mortality of 67%. When associated with aortic reconstructions, mesenteric ischemia carried a mortality of 100% if bowel infarction occurred after operation, but when prophylactic mesenteric revascularization was performed at the time of aortic surgery, prognosis was greatly improved, with only one death among six patients. An aggressive approach including prompt arteriography with early diagnosis and surgical therapy is advocated for these catastrophic acute mesenteric problems.     

Surgical treatment of chronic mesenteric arterial insufficiency

The treatment of 41 patients with chronic mesenteric insufficiency is reviewed: 20 men and 21 women with a mean age of 59 years were treated and observed for an average of 42 months. Thirty-one patients had symptoms of intestinal angina whereas 10 patients underwent prophylactic revascularization during other aortic operations. All but one patient had revascularization of the superior mesenteric artery, alone or in combination with another revascularization. Various surgical techniques were used, including retrograde bypass in 24 patients, antegrade bypass in 11 patients, and endarterectomy in the remaining six patients. Seven patients had acute abdominal symptoms and required emergency operation while in the hospital awaiting elective revascularization. There were two deaths in the perioperative period (4.9%), both caused by bowel necrosis. Six patients are known to have had late revascularization failure, resulting in recurrent symptoms in three patients and two subsequent deaths. All patients who remained asymptomatic after late graft failure had undergone multiple vessel revascularization; no patient revascularized prophylactically had symptoms of intestinal angina during the follow-up period. Early mesenteric revascularization is a safe and effective method of relieving the symptoms of chronic visceral ischemia and may prevent the development of fatal bowel necrosis.     

Revascularization to Prevent Postoperative Bowel Infarction After Surgery for Acute Superior Mesenteric Artery Thromboembolism

Purpose. Postoperative bowel infarction is a major contributing factor to the high mortality rate associated with acute thromboembolism of the superior mesenteric artery (SMA). This study was conducted to evaluate the prophylactic role of thrombectomy to prevent postoperative mesenteric infarction. Methods. An autologous fibrin clot (1 cm³) was implanted into the SMA of beagle dogs. The animals in group I (n = 7) underwent only resection of the ischemic intestine 120 min after insertion of the thrombus. In group IIa (n = 6), the intestine was removed before thrombectomy of the SMA, and revascularization was performed 30 min prior to resection in group IIb (n = 6). The postoperative outcomes were compared among the three groups. Results. Postoperative bowel infarction developed in four (57.1%) of the group I dogs, three (42.8%) of which died within 5 days postoperatively. The SMA was patent in the group IIa and IIb dogs, none of which died throughout the observation period. Performing thrombectomy before the resection reduced the length of resected intestine. Conclusion. Arterial revascularization is not only an essential procedure for mesenteric infarction due to SMA thromboembolism, but it also prevents the postoperative bowel infarction caused by the extension of thrombus in the mesentery. Received: February 2, 2001 / Accepted: July 17, 2001     

Mesenteric venous thrombosis occurring late after splenectomy

Two patients with mesenteric venous thrombosis which occurred late after splenectomy are reported. In the first case the thrombosis was seen, with preceding thrombocytosis, 3 years after splenectomy. In the second case the thrombosis occurred 2 years and 5 months postoperatively. Platelet counts had not been obtained before the mesenteric thrombosis in this case. In both instances persistent severe anaemia for several weeks preceded the symptoms and signs of mesenteric venous thrombosis. Both patients were treated by extended resection of the affected small bowel. Thus, dangerous thrombocytosis may occur in the presence of persistent severe anaemia even late after splenectomy. Thrombocytosis occurring immediately after splenectomy, which is almost inevitable, should be treated with heparin or other anticoagulants. In the late period the avoidance of persistent severe anaemia seems to be important in the prevention of thrombotic complications due to reactive thrombocytosis in splenectomized patients.     

Home parenteral nutrition: Westmead Hospital experience

Home parenteral nutrition (HPN) has been used in 13 patients over a 7 year period for intervals ranging from 14 to 608 days with a mean of 255 days. This represents a total experience of 3315 patient days or 9.1 patient years. The commonest causes for intestinal failure requiring HPN were short bowel syndrome following massive small bowel resection for mesenteric ischaemia (four patients), and radiation enteritis (three patients). Four patients died, including three of four who had presented with mesenteric ischaemia and one from disseminated malignancy. One of the deaths was from massive pulmonary embolus and may have been catheter-related. Seven patients were able to cease HPN after a mean of 200.7 days because of treatment and/or improvement in the underlying cause of their intestinal failure. Central venous thrombosis was the commonest complication and occurred in six patients, including the four who died.     

急性原发性肠系膜上静脉血栓形成17例临床诊治分析

目的:探讨急性原发性肠系膜上静脉血栓形成(APSMVT)的临床诊断与治疗。方法:回顾性分析我院1998年至2007年收治的17例APSMVT的临床资料。结果:17例病人(100%)均有持续性渐行加重的腹痛,常见伴随症状有恶心呕吐(82%)、消化道出血(53%)、肠梗阻(53%)、发热(59%)等。11例(65%)腹腔穿刺获血性腹水。17例均行超声检查,1例术前明确诊断;14例CT检查中2例增强扫描后得以确诊,12例平扫可见间接征象。16例行坏死肠段切除手术及抗凝治疗,其中3例首次剖腹探查未见异常,在症状未缓解或加重后再次手术发现肠坏死并行肠切除。2例病人行经皮肝穿刺肠系膜上静脉导管溶栓治疗,1例血栓复发者行肠系膜上动脉导管溶栓后治愈。3例术后因脓毒症死亡。结论:APSMVT术前诊断困难,对不明原因急性剧烈腹痛者应及时怀疑本症,早期发现、早期治疗方能提高本病的治愈效果。病程早期可采用介入溶栓疗法,后期出现肠坏死征象者应及时手术,并予以抗凝治疗。     

Treatment of mesenteric infarction

Eighty-one cases of mesenteric infarction documented by angiography, laparotomy or autopsy were reviewed to assess the cause of the persistently high mortality. Thirty-seven patients (46 per cent) were felt to have inoperable lesions and were treated by supportive care only, while forty-four (54 per cent) underwent bowel resection and/or revascularization. Of these 44 patients 20 (45 per cent) survived, 14 (32 per cent) died of an early recurrence of infarction and 10 (23 per cent) died of an unrelated cause. In view of the high recurrence rate in the early postoperative period, treatment must prevent the causes of persistent or recurrent ischaemia such as vasoconstriction and reperfusion tissue damage. On the basis of recent clinical and experimental research we suggest that treatment should include routine angiography with selective perfusion of vasodilators through the superior mesenteric artery, pharmacological prevention of ischaemic and reperfusion tissue damage before surgery, and postoperative anticoagulation.     

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.