妊娠早期合并肠系膜静脉血栓形成一例报告并文献复习

发布时间：2018-04-23 09:11

  本文选题：妊娠 + 肠系膜　； 参考：《浙江大学》2017年硕士论文

【摘要】：目的:探讨妊娠早期合并肠系膜静脉血栓形成的临床特征及诊治现状。方法:对2016年慈溪市第三人民医院收治的1例妊娠早期合并肠系膜静脉血栓形成患者病例进行报道,并复习国内外1996～2016年相关文献,共收集到4个病例对疾病进行回顾性分析。结果:发病孕周跨度为6～12周。4例均以腹痛为首发症状,伴有不同程度恶心、呕吐等症状,其中2例误诊为流产和急性胰腺炎。1例有脾切除史,1例抗凝血酶缺乏,1例蛋白S缺乏。患者均经多普勒超声、CT或手术诊断,1例通过低分子肝素抗凝保守治疗治愈,3例行坏死肠管切除术及肠吻合术。母体预后均良好,1例术后继续妊娠至足月分娩,1例发生于药物流产后,2例在血栓稳定后选择人工流产终止。结论:妊娠早期合并肠系膜血栓形成极为罕见,易栓症是其主要病因。临床变现无特异性,主要表现为腹痛,诊断需要根据临床表现及辅助检查进行综合判断,CT最具诊断价值。对于妊娠早期出现腹痛且有易栓症高危因素的患者,应尽早鉴别排除。对疑似病例,尽早使用以低分子肝素抗凝为主的综合治疗,对于治疗期间出现严重腹膜炎体征患者,及时手术探查并切除坏死肠管是保障母婴安全的关键。
[Abstract]:Objective: to investigate the clinical features, diagnosis and treatment of mesenteric venous thrombosis in early pregnancy. Methods: a case of mesenteric venous thrombosis in early pregnancy was reported in the third people's Hospital of Cixi City in 2016. The related literatures from 1996 to 2016 were reviewed and 4 cases were collected and analyzed retrospectively. Results: abdominal pain was the first symptom in 4 cases with different degrees of nausea and vomiting. Among them, 2 cases were misdiagnosed as abortion and acute pancreatitis, 1 case had history of splenectomy, 1 case had antithrombin deficiency and 1 case had S deficiency. All the patients were diagnosed by Doppler ultrasound CT or surgery. One case was cured by low molecular weight heparin anticoagulant conservative treatment. 3 cases underwent necrotizing enterectomy and enterostomy. The maternal prognosis was good in all cases. 1 case continued pregnancy to term delivery 1 case occurred after drug abortion and 2 cases chose abortion termination after thrombus stabilization. Conclusion: mesenteric thrombosis is rare in early pregnancy and thrombotic disease is the main cause. Clinical manifestation is not specific, the main manifestation is abdominal pain, the diagnosis needs to be based on clinical manifestations and auxiliary examinations to comprehensively judge the diagnostic value of CT. Patients with abdominal pain in early pregnancy and risk factors of thrombus risk should be identified and excluded as soon as possible. For suspected cases, early use of low-molecular-weight heparin anticoagulant therapy, for severe peritonitis signs during the treatment, timely surgical exploration and excision of necrotic intestinal tube is the key to ensure the safety of mother and child.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.255
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本文编号：1791324