肠系膜上静脉血栓形成诊疗应注意的问题

肠系膜上静脉血栓形成(superior mesenteric vein thrombosis,SMVT)是肠缺血疾病中的一种,临床上较为少见,然而通常是致命性的。由于SMVT发病率较低及临床表现缺乏特异性,早期诊断难度较大,病死率较高。影像学检查的进展使得SMVT早期诊断成为可能,其中CT由于具有较高的敏感性及特异性,应作为临床首选检查手段。SMVT一经诊断,应立即予以抗凝治疗,以抗凝治疗为基础的保守治疗无效时,可考虑进一步行腔内治疗及手术治疗。任何时候,一旦出现疑似肠坏死的情况,应立即予以外科手术治疗。

The Diagnosis and Treatment of Superior Mesenteric Vein Thrombosis

Superior mesenteric venous thrombosis （SMVT） is an uncommon but often lethal form of bowel ischemia. Usually, because of its rare occurrence and nonspecificity of clinical manifestation, delay in diagnosis is frequent and contrib- utes to its high mortality rate. Recent advances in imaging modalities have facilitated an early diagnosis, among which compu- ted tomography should be the preferred examination method because of its high sensitivity and specificity in the diagnosis of SMVT. As soon as the diagnosis of SMVT is confirmed, anticoagulation therapy should be initiated. If the conservative treat- ment based on anticoagulation therapy did not work, further treatment, including endovascular therapy and surgery, should be considered. Whenever bowel infarction is suspected, surgery should be performed immediately.