脾切除断流术后急性肠系膜静脉血栓形成诊治的陷阱和对策  

Danger points and strategy for diagnosis and treatment of acute mesenteric venous thrombosis after splenectomy and devascularization

作　　者：何磊 文刚 刘少军[2] 孟翔凌[3] 张长乐[3] 徐阿曼[3] 

机构地区：[1]安徽医科大学第三附属医院胃肠外科,合肥230061 [2]安徽省立医院胃肠外科 [3]安徽医科大学第一附属医院胃肠外科

出　　处：《腹部外科》2016年第4期285-288,共4页Journal of Abdominal Surgery

基　　金：安徽省科技厅国际合作项目(1503062025)

摘　　要：目的分析脾切除断流术后肠系膜静脉血栓形成诊治的陷阱和对策。方法回顾分析2009年1月至2015年1月收治肠系膜静脉血栓形成病人223例,其中有肝硬化门静脉高压症行脾切除贲门周围血管离断手术史病人26例,男性15例,女性11例,平均年龄(51±4)岁,26例病人均有持续性进行性加重的腹痛(。100%),恶心、呕吐21例(80.8%),腹泻18例(69.2%),血便15例(57.7%),肠梗阻21例(80.8%),腹腔血性渗出液22例(84.6%),总结其临床特点、诊断及治疗方法。结果26例病人中,入院时误诊22例,误诊率84.6%,CT确诊12例,剖腹探查手术确诊14例;行抗凝治疗治愈4例,手术切除坏死肠管22例;术后因多器官功能障碍综合征死亡1例。结论脾切除断流术后肠系膜静脉血栓形成症状无特异性,存在诸多陷阱和误区,误诊率高,医生对本病的深刻认识和重视是早期诊断的关键。Objective To analyze the danger points and strategy for clinical diagnosis and treat- ment of acute mesenteric venous thrombosis （AMVT） after splenectomy and devascularization. Meth- otis The clinical data of 26 patients with AMVT were analyzed retrospectively. The clinical features, diagnosis and treatment were summarized. There were 15 males and 11 females with the age ranging [rom 44 to 78 years old （mean 51 ± 4）. The symptoms in 26 cases was aggravating abdominal pain with insidious onset （100%）, nausea or vomiting 21 cases （80. 8%）, diarrhea 18 cases （69. 20% ）, blood in the stool in 15 cases （57. 7%）, intestinal obstruction in 21 cases （80. 8%）, and abdominal bloody exudate in 22 cases （84. 6%）. Results There were 22 cases of delayed diagnosis with rnisdiag- nosis rate being 84. 6%. AMVT was preoperative definitely diagnosed by CT in 12 cases, and by sur- gery in 14 cases. Four cases of AMVT were cured by anticoagulant therapy, and 22 cases of AMVT were given surgical resection of necrotic bowel. One case died of postoperative MODS. Conclusions AMVT after splenectomy and devascularization has no characteristic symptoms and easily misdiagno- sis. Many traps and misunderstandings exist in the process of diagnosis. The doctor＇s profound under- standing and attention of this disease is the key to early diagnosis.

关 键 词：肝硬化 脾切除 断流术 急性肠系膜静脉血栓形成 诊断 

分 类 号：R657.3[医药卫生—外科学]