急性肠系膜上静脉血栓形成的诊治分析  

Clinical management of acute superior mesenteric vein thrombosis

作　　者：王吉[1] 王曦 张国敬[1] 陆礼[1] 闫永嘉[1] 付蔚华[1] Wang Ji;Wang Xi;Zhang Guojing;Lu Li;Yan Yongiia;Fu Weihua(Department of General Surgery,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院普通外科,300052

出　　处：《中华普通外科杂志》2018年第12期1034-1037,共4页Chinese Journal of General Surgery

摘　　要：目的探讨急性肠系膜上静脉血栓形成(acute superior mesenteric venous thrombosis,ASMVT)的临床诊治经验。方法回顾性分析天津医科大学总医院普通外科2014年1月至2017年10月收治的36例ASMVT患者的临床资料,比较非手术治疗组和手术治疗组患者的临床资料及预后差异。结果本组36例ASMVT患者在诊断后均立即予抗凝治疗,治疗后再通率42%。手术治疗组21例,其中急诊手术9例,延迟性肠切除12例。非手术治疗组与手术治疗组患者在入院时血红蛋白值相比差异有统计学意义[(124±29)g/L比(93±13)g/L,t=3.880,P=0.006]。急诊手术组较延迟性肠切除组切除肠管距离长[(65±58)cm比(13±6)cm,t=2.700,P=0.035],小肠双腔造瘘多(6例比1例,x^2=7.875,P=0.016),术后并发症发生率高(56%比8%,x^2=5.619,P=0.046),但两组在住院时间、住院费用、术后复发率、死亡率方面相比差异均无统计学意义(均P>0.05)。结论在ASMVT的患者中,早期积极抗凝治疗有可能避免肠切除、或者缩小肠切除范围。经积极抗凝治疗仍有肠梗阻的患者如能过渡到延迟性、确定性肠切除手术可能是最佳的治疗方式。Objective To evaluate the diagnosis and treatment of acute superior mesenterie venous thrombosis (ASMVT).Methods Clinical data of 36 ASMVT patients admitted to our department from Jan 2014 to Oct 2017 were retrospectively analyzed,the differences of the clinical data and prognosis of nonsurgical group and surgical group were studied.Results All patients received anticoagnlation therapy immediately after diagnosis,and recanalization rate was 42%.Surgical group included 21 cases,of which 9 cases received emergency surgery,12 cases received delayed bowel resection.There was significant difference between non-surgical group and surgical group (P>0.05)in hemoglobin level at admission (124±29)g/L vs.(93±13)g/L,t =3.880,P =0.006.Compared with delayed bowel resection group emergency surgery group had longer bowel resection (65±58)cm vs.(13±6)cm,t =2.700,P =0.035, more loop ileostomy (6vs.1,x^2=7.875,P=0.016),more postoperative complication rate (56% vs. 8%,x^2=5.619,P=0.046),but there was no significant difference in hospitalization time,hospitalization cost,postoperative recurrence and mortality rate (P>0.05).Conclusions Early antieoagulantion therapy is advised for ASMVT patients to avoid bowel resection or reduce the length of intestinal resection.It is advisable for those who can be tided over to delayed bowel resection with intestinal obstruction.

关 键 词：静脉血栓形成 肠系膜静脉 肠切除术 

分 类 号：R657.2[医药卫生—外科学]