急性肠系膜静脉血栓形成的腔内治疗  

Endovascular treatment of acute mesenteric venous thrombosis

作　　者：金良 徐江[1] 汪丹青 王筝[1] Jin Liang;Xu Jiang;Wang Danqing;Wang Zheng(Department of Vascular Surgery,Tongling People's Hospital,Tongling 244000,Anhui,China)

机构地区：[1]铜陵市人民医院血管外科,安徽铜陵244000

出　　处：《血管与腔内血管外科杂志》2022年第12期1483-1488,共6页Journal of Vascular and Endovascular Surgery

摘　　要：急性肠系膜静脉血栓形成(AMVT)是一种肠系膜缺血性疾病,可引起肠壁水肿、肠壁血液循环障碍、肠道细菌移位、败血症、肠道坏死、腹腔感染、腹腔积液及多器官功能障碍综合征,可出现腹痛、腹胀、恶心、呕吐等非特异性临床表现,还可发生血流动力学不稳定的表现。诊断主要依靠影像学检查,目前以肠系膜血管增强计算机断层扫描(CT)检查为主,治疗方式以禁食、补液、预防性抗感染、抗凝等保守措施为主,对于保守治疗过程中出现病情恶化的患者,可采用血管腔内治疗,若出现肠管坏死,则需要进行手术切除。血管腔内治疗途径包括经皮经肝、经颈静脉肝内门体分流术(TIPS)的直接途径,经肠系膜上动脉的间接途径,动静脉联合途径,经皮经脾途径等,不同途径的适应证侧重有所不同。腔内治疗方式包括吸栓、碎栓、溶栓等,以溶栓最常见,诊治的及时性与预后情况密切相关。AMVT诊治过程中应贯彻损伤控制性外科与多学科协作的理念以及进阶式的诊断、治疗策略。Acute mesenteric venous thrombosis(AMVT) is a kind of mesenteric ischemic disease, which can cause intestinal wall edema, intestinal wall blood circulation disorder, intestinal bacterial migration, sepsis, intestinal necrosis,abdominal infection, abdominal effusion and multiple organ dysfunction syndrome. Non-specific clinical manifestations such as abdominal pain, abdominal distention, nausea and vomiting as well as hemodynamic instability may occur. The diagnosis mainly depends on imaging examination, at present, the mesenteric vascular enhanced computer tomography(CT) examination is the most common and reliable. The main treatment methods are fasting, fluid rehydration,preventive anti-infection, anticoagulation and other conservative measures. For the deterioration of the disease in the process of conservative treatment, endovascular treatment can be used, and if intestinal necrosis occurs, surgical resection is required. Endovascular treatment approaches include direct approach such as percutaneous transhepatic and transjugular intrahepatic portosystemic shunt(TIPS), transsuperior mesenteric artery indirect approach, combined arteriovenous approach, percutaneous transsplenic approach, and so on. Different approaches have different emphasis on indications. Endovascular treatment includes thrombus aspiration, thrombus crushing and thrombolysis, with thrombolysis being the most common, the timeliness of diagnosis and treatment is closely related to prognosis. During the diagnosis and treatment of AMVT, the concept of injury control surgery and multidisciplinary cooperation as well as advanced diagnosis and treatment strategies should be implemented.

关 键 词：急性肠系膜静脉血栓形成 血管腔内治疗 肠系膜缺血 抗凝治疗 

分 类 号：R543[医药卫生—心血管疾病]