肠系膜上静脉血栓形成临床诊治的单中心回顾性研究  

Risk factors and treatment outcomes in patients with superior mesenteric venous thrombosis:a single-center retrospective report

作　　者：王斯文[1] 姚陈[1] 王劲松 胡作军[1] 王冕[1] 李梓伦[1] 宁俊杰 秦原森 石毅 崔进[1] 王深明[1] 常光其[1] Wang Siwen;Yao Chen;Wang Jinsong;Hu Zuojun;Wang Mian;Li Zilun;Ning Junjie;Qin Yuansen;Shi Yi;Cui Jin;Wang Shenming;Chang Guangqi(Division of Vascular Surgery,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China;Department of Vascular Surgery and Plastic surgery,Guangdong Provincial People's Hospital,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院血管外科,广州510080 [2]广东省人民医院血管与整形外科,广州510080

出　　处：《中华血管外科杂志》2021年第3期161-166,共6页Chinese Journal of Vascular Surgery

基　　金：广东省自然科学基金项目(S2013040012593)。

摘　　要：目的探讨肠系膜上静脉血栓形成(SMVT)合理的诊断与治疗方法。方法回顾性分析2003年1月至2017年12月中山大学附属第一医院收治的128例SMVT患者的临床资料。其中男性88例,女性40例,年龄(41.78±14.22)岁。根据治疗方式分为手术治疗组(46例)和保守治疗组(82组)。对SMVT患者的病例特点、症状体征、住院诊治情况和随访情况进行统计学分析比较。结果128例SMVT患者中,急性发病者(发病<14 d)98例,急性患者中采用手术或保守治疗比例差异无统计学意义(39/46比59/82,χ^(2)=1.734,P=0.100)。有症状患者125例;其中手术治疗组中恶心(54.35%比29.27%,χ^(2)=7.845,P=0.005)、呕吐(52.17%比28.05%,χ^(2)=7.381,P=0.007)、腹胀(54.35%比32.93%,χ^(2)=5.606,P=0.018)、肛门停止排气排便(39.13%比17.07%,χ^(2)=7.647,P=0.006)、反跳痛(78.26%比35.37%,χ^(2)=21.690,P<0.001)、腹肌紧张(67.39%比21.95%,χ^(2)=25.750,P<0.001)、移动性浊音(32.61%比9.76%,χ^(2)=10.440,P=0.001)以及呼吸急促(13.04%比2.44%,P=0.017)、心率增快(45.65%比12.20%,χ^(2)=17.970,P<0.001)、血压降低(18.70%比1.22%,P=0.036)比率均高于保守治疗组,差异有统计学意义。另外,手术治疗组中诊断性腹腔穿刺阳性比例较高(15比0,P<0.05)。118例患者接受抗凝治疗,手术治疗组全部接受抗凝治疗。43例患者接受溶栓治疗。住院期间无死亡病例。46例手术患者均手术成功,急诊手术占91.30%(42/46),手术方式主要为剖腹探查及坏死肠段切除。术后主要并发症为腹腔感染(6.52%,3/46)、切口感染(6.52%,3/46)。72例患者获得随访,随访时间(83.26±27.91)个月。随访期内肠梗阻10例,肠缺血5例,消化道出血4例及短肠综合征6例。非SMVT相关死亡5例,均为保守治疗患者。结论SMVT如出现高度怀疑肠坏死的临床表现和体征,或行腹腔穿刺术抽出不凝血性液体,应及时行手术切除坏死肠管或挽救缺血肠道。早期抗凝治疗对于缓解病情及改善预后至Objective To investigate the most appropriate strategies for the diagnosis and the treatment of superior mesenteric venous thrombosis(SMVT).Methods A retrospective analysis was performed on the clinical data of 128 patients with SMVT admitted to the First Affiliated Hospital of Sun Yat-sen University from January 2003 to December 2017.Among all the cases,there were 88 males and 40 females,with a age of(41.78±14.22)years.The patients were divided into two groups according to the treatment method:surgery group(n=46)and conservative treatment group(n=82).The clinical characteristics,symptoms and signs,hospitalization and follow-up of cases in both two groups were statistically analyzed and compared to summarize the clinical outcome and prognosis of SMVT.Results Of all the 128 SMVT patients,98 cases presented acute onset(time period<14 days)and among them,there was no statistically significant difference in the proportion of patients received surgery or conservative treatment(39/46 vs.59/82,χ^(2)=1.734,P=0.100).There were 125 symptomatic patients(97.65%).The incidence rate of nausea(54.35%vs.29.27%,χ^(2)=7.845,P=0.005),vomiting(52.17%vs.28.05%,χ^(2)=7.381,P=0.007),abdominal distension(54.35%vs.32.93%,χ^(2)=5.606,P=0.018),cessation of defecation(39.13%vs.17.07%,χ^(2)=7.647,P=0.006),rebound-tenderness(78.26%vs.35.37%,χ^(2)=21.690,P<0.001),abdominal muscle tension(67.39%vs.21.95%,χ^(2)=25.750,P<0.001),shifting dullness(32.61%vs.9.76%,χ^(2)=10.440,P=0.001),shortness of breath(13.04%vs.2.44%,P=0.017),increased heart rate(45.65%vs.12.20%,χ^(2)=17.970,P<0.001),and decreased blood pressure(18.70%vs.1.22%,P=0.036)were significantly higher in the surgery group than in the conservative treatment group.In addition,the proportion of patients with positive diagnostic peritoneocentesis in the surgery group was significantly higher than that in the conservative treatment group(15 vs.0,P<0.05).A total of 118 patients underwent anticoagulant therapy including all cases in the surgery group while 43 patients went through thro

关 键 词：肠系膜上静脉血栓形成 早期诊断 抗凝治疗 手术治疗 

分 类 号：R657.2[医药卫生—外科学]