急性肠系膜上静脉血栓形成的诊治  

Diagnosis and treatment of acute mesenteric venous thrombosis

作　　者：李学锋[1] 谷涌泉[1] 余恒锡[1] 张建[1] 孙家邦[1] 董宗俊[1] 李建新[1] 汪忠鎬[1] 

机构地区：[1]首都医科大学宣武医院血管外科,北京100053

出　　处：《中国普通外科杂志》2009年第6期602-604,共3页China Journal of General Surgery

摘　　要：目的探讨急性肠系膜上静脉血栓形成(AMVT)的诊断治疗方法。方法回顾性分析11例AMVT患者的临床资料,9例行腹部增强CT确诊,7例患者确诊后立即行抗凝及溶栓治疗;4例患者行手术治疗。结果11例AMVT患者死亡3例,总病死率27.3%,其中非手术治疗7例死亡1例,病死率14.3%;手术治疗4例死亡2例,病死率50.0%。8例存活者给予长期抗凝治疗。经平均64.7月随访,复发1例,死亡1例结论增强CT扫描对于AMVT的诊断及鉴别至关重要,对怀疑AMVT者应首选增强CT扫描确诊。AMVT如果能早诊治就可避免发展至肠坏死或穿孔,从而降低病死率。采用长期抗凝治疗可降低AMVT复发并提高长期生存率。Objective To study the methods of diagnosis and treatment of acute mesenteric venous thrombosis （AMVT）. Methods The clinical data of 11 cases of AMVT were analyzed retrospectively. Computed tomography （CT） was diagnosed in 9 of 11 patients. Seven patients with AMVT were initially treated with anticoagulation and thrombolysis, while the other 4 patients underwent surgical operation. Results Three of 11 patients died （ mortality rate 27. 3 % ）. Seven patients were initially treated nonoperatively and one of them died （ 14.3 % ） ; 4 patients underwent surgical operation and two of them died （ 50 % ）. Eight survivors were treated with long-term warfarin therapy. Seven of 8 patients survived in long-term （ mean, 64. 7 mouths ） and one patient had recurrence. Conclusions CT scanning appears to be the first and primary diagnostic test of choice when AMVT is suspected. If diagnosed and treated early, AMVT is not likely to progress to cause gangrenous bowel and thus the mortality rate can be decreased. Long-term anticoagulant therapy can increase survival rate and has a low recurrence rate.

关 键 词：静脉血栓形成 肠系膜静脉 抗凝 溶栓 

分 类 号：R654.4[医药卫生—外科学]