急性肠系膜上静脉血栓96例临床特点分析  

Analysis of clinical characteristics of 96 patients with acute superior mesenteric venous thrombosis

作　　者：刘文徽[1] 吴健[2] 李军[1] 万军[1] 吴本俨[1] 

机构地区：[1]解放军总医院南楼消化科,北京100853 [2]解放军313医院肾内科,辽宁葫芦岛125000

出　　处：《解放军医学杂志》2015年第5期400-403,共4页Medical Journal of Chinese People's Liberation Army

基　　金：解放军总医院临床科研扶持基金(2013FC-TSYS-1004)~~

摘　　要：目的探讨急性肠系膜上静脉血栓(ASMV T)的临床特点。方法回顾性分析解放军总医院2000年1月-2013年12月确诊的96例ASMV T患者的临床资料,死亡相关危险因素,以及不同治疗方式和不同部位血栓对患者结局的影响。结果 96例ASMVT患者中男72例,女24例,年龄46.9±15.5岁;生存83例,死亡13例,死亡发生率13.5%;孤立性肠系膜上静脉血栓(SMVT)39例,联合SMVT 57例。死亡组合并重症胰腺炎及孤立SMVT的比例高于生存组(P<0.01)。依不同治疗方式分为开腹手术组(n=23)、介入溶栓组(n=62)和保守治疗组(n=11)。开腹手术组患者自发病至接受治疗的时间最短,孤立SMVT发生率最高,死亡发生率也高于介入溶栓组及保守治疗组。保守治疗组中无死亡病例。孤立SMVT组出现腹膜刺激征、行开腹手术及发生肠坏死的例数均高于联合SMVT组(P<0.01或P<0.05),发生于脾切除术后的患者比例低于联合SMVT组(P=0.002)。结论孤立SMVT因更易出现腹膜刺激征、更易发生肠坏死而需行开腹手术;联合SMVT易发生在脾切除术后;在重症胰腺炎的基础上发病是ASMVT患者死亡的相关危险因素。Objective To investigate the clinical characteristics of patients suffering from acute superior mesenteric venous thrombosis（ASMVT）. Methods Clinical data of 96 ASMVT patients admitted to the PLA General Hospital from January 2000 to December 2013 were retrospectively analyzed. Clinical characteristics and death-associated risk factors were studied, and the influence of treatment strategy and thrombosis location on patients’ outcome were analyzed. Results The patients were divided into survival group（n=83） and death group（n=13） according to the outcome. The mean age was 46.9 years old, and the ratio of male/female was 3：1. Thirty-nine patients presented isolated superior mesenteric venous thrombosis（SMVT） and fiftyseven patients presented combined SMV T. In the death group, higher incidence of severe acute pancreatitis and isolated SMV T were found than the sur vival group（P〈0.01, P=0.004）. The patients were again divided into laparotomy group, inter ventional thrombolysis group, and conservative treatment group according to treatment modality. The interval between symptom onset and treatment was shorter, the incidence of isolated SMVT and mortality rate were higher in the laparotomy group compared with those in interventional thrombolysis group and conservative treatment group. There was no death in the conservative treatment group. In comparison with the combined SMVT group, more patients in the isolated SMVT group presented peritoneal signs and less with history of splenectomy（P〈0.001, P=0.002）. The proportion of patients with laparotomy and bowel necrosis in the isolated SMVT group was higher than those in the combined SMVT group（P=0.023, P=0.012）. Conclusions Patients with isolated SMVT are more likely to have peritoneal signs and bowel necrosis, surgical treatment is mandatory. Patients with combined SMVT often have a history of splenectomy. ASMVT patients with severe pancreatitis may present higher mortality rate.

关 键 词：肠系膜血管闭塞 静脉血栓形成 胰腺炎 急性坏死性 

分 类 号：R572.3[医药卫生—消化系统]