肠系膜静脉病变导致的缺血性肠病的临床病理分析

目的探讨肠系膜静脉病变导致的缺血性肠病的临床及病理特征。方法对2003—2004年间收集到的肠系膜血管病变导致的缺血性肠病3例进行临床病理的系统分析。结果肠系膜静脉炎继发静脉血栓导致缺血性肠病,临床上以急性腹痛起病,可并发腹膜炎,急诊剖腹探查术中发现有坏死的病变肠段,切除后组织学检查在肠壁的黏膜下层和肠系膜的小到中等大小的静脉壁中有以淋巴细胞为主的炎细胞浸润,血管壁纤维素样坏死,血栓形成;但动脉未受累及。1例缺血性肠病在2年多的随访过程中没有局部的复发或发展成系统性的静脉炎。结论肠系膜静脉炎导致的缺血性肠病是一种罕见的疾病,是静脉的炎症病变,可逐渐导致血栓的形成,最后导致肠道的充血、缺血和坏死。该病可能有自限性,病变肠段的外科切除可以治愈。

Clinicopathologic study of ischemic intestinal disease due to mesenteric venous lesions

Objective To study the clinical and pathologic features of ischemic intestinal disease due to mesenteric phlebitis. Method The clinical and pathologic features of the mesenteric venous lesions in 3 patients of ischemic intestinal disease admitted during the period from 2003 to 2004 were studied. Results All 3 patients had a clinical history of acute abdominal pain accompanying with a diffuse peritonitis. During operation, an infarcted intestinal segment was identified and was resected respectively in each patient. Histologic examination showed a lymphocytic infiltration and fibrinoid necrosis of the small to medium-sized veins, associated with mural thrombosis and infarction of the corresponding intestinal wall and mesentery. The mesenteric arteries were spared, Two-year follow up of one case showed no evidence of local recurrence or systemic vasculitis, Conclusions Ischemic intestinal disease due to mesenteric phlebitis is a rare entity with a pathological feature of inflammation of venous wall accompanying with the development of mural thrombosis and subsequent haemorrhagic infarction of intestine, The etiology is unknown and surgical resection of the involved intestinal segment is usually recommended.