肠系膜静脉血栓形成 23例诊治分析

目的探讨肠系膜静脉血栓形成( MVT)的早期诊断及治疗方法.方法回顾性分析 23例 MVT患者的临床资料.结果 23例患者中男 17例,女 6例;平均年龄 42岁.有 20例为急性 MVT,症状包括腹痛腹胀、恶心呕吐、便血等.彩色多普勒超声的检出率 94.1%;腹部 CT的检出率 100%.非手术治疗包括抗凝、溶栓及对症等,治愈率 81.8% (9/11例 );手术治疗 12例,包括肠切除和 Fogarty导管经肠系膜切缘的静脉分支切除肠系膜静脉血栓;手术并发症 33.3% (4/12例 ),其中顽固性腹水 2例,进食后腹痛 2例.住院期间死亡 2例 (8.7% ).随访 2个月至 9年,复发 3例,系出院后自行停用抗凝药物;死亡 3例,死因分别为心肌梗死、肝癌和肝硬化.结论彩色多普勒超声和 CT扫描对 MVT的早期诊断有较高的诊断价值;抗凝治疗和手术是 MVT有效的治疗手段.

Clinical analysis of mesenteric venous thrombosis:a report of 23 cases

Objective To assess the early clinical diagnosis and treatment of mesenteric venous thrombosis (MVT). Methods Clinical data of 23 cases with MVT from January 1994 to December 2003 were analyzed retrospectively. Results There were 17 males and 6 females,the age ranged from 19 to 74 years old with a mean age of 42 years. Of them,20 patients presented acute MVT. The main symptoms included abdominal pain and distention,nausea,vomiting,and bloody stool. The detectable rates of transabdominal color Doppler ultrasonography and CT for MVT were 94.1%and 100%respectively. Nine of 11(81.8%) patients were cured with non-surgical management. Twelve patients underwent surgical treatments including resection of the infarcted bowel and open mesenteric venous thrombectomy with Fogarty catheter via a branch of mesenteric vein. The in-hospital mortality rate was 8.7%,and the postoperative morbidity rate was 33.3%,including ascites in 2 patients and postprandial abdominal pain in other 2 patients. After follow-up from 2 months to nine years,3 patients had MVT recurrence because of ceasing anti-coagulation treatment and 3 died of myocardial infarction,liver cancer and hepatic cirrhosis. Conclusion Color Doppler ultrasonography and CT scanning are valuable diagnostic methods for MVT,and anticoagulation treatment and operation are effective managements.