肠系膜静脉血栓形成31例临床分析

目的 分析肠系膜静脉血栓形成的临床特点,探讨其早期诊断和治疗方法.方法回顾性分析31例肠系膜静脉血栓形成患者的临床资料.结果31例患者中,急性组19例,36.8%患者有肢体血栓性静脉炎或肺栓塞史,均以腹痛为首发症状,并进行性加重,57.9%患者出现腹膜刺激征,68.4%出现腹水征;13例患者经腹部CT或选择性血管造影检查确诊,CT检出率83.3%;93.3%患者血浆D-二聚体升高;手术治疗13例,抗凝治疗6例,病死率15.8%,复发率21.1%,2例死亡.慢性组12例,均无急腹症表现,经腹部CT检查确诊,66.7%患者出现上消化道出血.结论肠系膜静脉血栓形成是一种缺乏特异性临床表现、病死率高的疾病,腹部CT检查对早期诊断有重要价值,及时手术、抗凝治疗可以降低病死率.

Clinical analysis of mesenteric venous thrombosis in 31 cases

Objective To analyze the clinical characteristics and determine the early diagnosis and treatment of mesenterie venous thrombosis (MVT). Methods Clinieal data of 31 cases with MVT were analyzed retrospectively. Results Of all 31cases,19 patients presented acute MVT. Abdominal pain was the first onset symptom and then progressively exacerbated; peritoneal irritation and ascites developed in 57.9% and 68.4 % patients with sign of ascites respectively. 13 patients were diagnosed by abdominal CT scan or selective mesenterie angiography; the detectable rate of CT for acute MVT was 83.3%. The level of plasma D-Dimer was increased in 93.3% patients with acute MVT. 13 patients underwent surgical treatment, among them,6 cases received anticoagnlafion treatment,4 cases recrudersced and 3 died. 12 chronic MVT patients had no symptoms and were identified through abdominal CT 8 cases developed upper gastrointestinal hemorrhage and 2 died. Conclusion The nonspecifie nature of the abdominal symptoms often delays the diagnosis of MVT and leads to high mortality. Abdominal CT is valuable diagnosis method for MVT and anticongulation treatment and operation are effective managements.