肠系膜静脉血栓形成的诊断和手术时机探讨

目的 探讨肠系膜静脉血栓形成(MVT)的诊治及手术时机。方法 回顾性分析9例MVT的临床资料,总结其既往史、发病时间与治疗方式、手术与非手术病人的临床表现和抗凝溶栓治疗的效果。结果 MVT发病以腹痛为主,9例之中有7例病人既往有血液高凝状态的病史。早期确诊的4例病人应用抗凝溶栓治疗,有3例非手术治愈。其余5例在发病后20～144h因腹膜炎而手术探查时确诊。手术切除肠管30～320cm。由于术后没及时应用抗凝治疗,1例发生了肠坏死而再次手术。结论 早期诊断、早期抗凝溶栓治疗能避免肠坏死,一旦出现腹膜炎或肠绞窄体征是手术探查的指征。手术时要正确判断尚有生机的肠管和尽量取出门静脉和肠系膜上静脉主干内的血栓。手术后继续抗凝溶栓治疗是保证疗效的关键。

Clinical analysis in 9 patients with mesenteric wenous thrombosis

Objective To evaluate the progress in diagnosis and the timing and indications of laparotomy for patients with mesenteric venous thrombosis(MVT). Methods Nine patients with MVT were reviewed retrospectively reviewed during a period from 1982 to 2000. The past history, the time of occurrence and the clinical manifestration were summarized. The standard of conservative or operative treatment and the effect of anticoagu-lation were respectively analysed. Results A progressive abdominal pain were found all patients. Seven of these 9 patients had a history of hypercoagulable states. Three of 4 patients were cured the anticoagulation and throml-cobtic therapy in the early stage of MVT. When the signs of acute peritonitis were found,a surgical exploration were performed in the remaining 5 cases, and the diagnosis of MVT was confirmed. Because of anticoagulative therapy was not timely after operation, the intestinal resection of second time was done in one case of re-occurred intestinal necrosis after 24 hours of first operation. Conclusion For avoiding intestinal necrosis, the early diagnosis, anticoagulation and thrombolytic therapy might be very important. Once the signs of pertonitis or intestinal strangulation present, immediute exploratory laparotomy should be indicated. If is necessary to remove out thrombus from portal vein or mesenteric vein. The status of intestine should be adequately jud ged during the operation. Timely and adequate application of anticoagulantis essential for decreasing mortality and recurrence of thrombosis.