术后早期肠系膜静脉血栓形成的诊断与治疗  

Diagnosis and treatment of mesenteric venous thrombosis early after operation

作　　者：潘凯[1] 夏利刚[1] 陈小春[1] 钟克力[1] 江厚象[1] 

机构地区：[1]暨南大学医学院第二附属医院暨深圳市人民医院胃肠外科,518020

出　　处：《中华胃肠外科杂志》2005年第1期50-52,共3页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的分析腹部术后早期肠系膜静脉血栓形成的临床特点及诊断与治疗。方法回顾性总结我院14年间7例腹部术后早期肠系膜静脉血栓形成患者的临床资料。结果患者均体胖,主要临床表现为持续剧烈的腹痛和呕吐,腹部体征相比较轻;有2例甚至出现全身中毒症状。腹部X线检查均提示肠梗阻;4例腹部CT检查,其中3例提示本病;6例术前腹腔穿刺出血性液体。7例患者均予以手术探查,分别切除长度不一的坏死小肠段。2例术后出现短肠综合征,其中1例因严重营养不良,衰竭死亡。4例术后反复出现门静脉、肠系膜静脉和髂静脉血栓,需出院后长期服用肠溶阿斯匹林或华法令钠。结论术后早期肠系膜静脉血栓形成在临床上无何特异性的症状和体征,极易误诊。治疗方面应强调及时地剖腹探查并配合使用全身性的抗凝溶栓药物。Objective To analyze the clinical characteristics,diagnosis and treatment of patients with mesenteric venous thrombosis early after operation. Methods A retrospective study was performed on the clinical data of 7 patients with mesenteric venous thrombosis early after operation from 1990 to 2004. Results Patients had main clinical manifestetations of severe abdominal pain and vomiting,but abdominal signs were slight. The systemic toxic symptoms occurred in 2 cases at late course. The examination of abdominal X ray showed intestinal obstruction of all patients. Four patients received abdominal CT scanning,of whom 3 patients were diagnosed as mesenteric venous thrombosis. Seven patients received exploratory operation. The necrotic intestinal segments were resected. Two patients had short intestinal syndromes after operation,one of them died of serious malnutrition. Four patients who had recurrence of portal,mesenteric and iliac venous thrombosis needed a long term therapy of warfarin and aspirin after discharge. Conclusions It is easy to make a mistake in diagnosis because of the lacking of characteristic clinical manifestations. Exploratory operation immediately plus anticoagulant therapy is strongly recommended.

关 键 词：肠系膜静脉血栓形成 术后早期 诊断与治疗 患者 腹部术后 肠溶阿斯匹林 出血性 强调 提示 反复 

分 类 号：R619[医药卫生—外科学]