88例肠系膜上静脉血栓形成的临床诊治分析

发布时间：2018-02-22 12:05

  本文关键词： 静脉血栓形成 肠系膜 肠坏死 Logistic回归分析　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨肠系膜上静脉血栓形成(SMVT)的临床特点及诊治经验。方法:回顾性分析我院2006年1月—2016年12月确诊的88例SMVT的临床资料,早期不同治疗方式和手术时机的选择对于患者预后的影响,根据是否存在肠梗死将其分成两组,其中经手术证实SMVT致肠坏死32例作为研究组,其余56例SMVT作为对照组,对其临床表现、实验室检查、影像学检查等综合指标进行统计,纳入相关影响因子行多因素Logistic回归分析,判断SMVT致肠坏死与临床危险因素的关系,并建立Logistic预测模型,评价其预测SMVT所致肠坏死的准确度、灵敏度、特异度。结果:88例SMVT患者中男62例,女26例,年龄53.4±12.4岁,住院期间,生存85例,死亡3例,病死率为3.5%。其中35例患者有腹部手术史,肝炎、肝硬化患者31例,恶性肿瘤史、心脑血管疾病史患者各4例,糖尿病史3例,系统性红斑狼疮1例,另外11例患者未发现显高危因素。腹痛为其主要临床表现,占99%,其中持续性及局限性各占33%、66%。其次分别是腹胀,呕吐,发热及便血等,各占64%、42%、33%、28%,所有患者均经过腹部强化CT、DSA、B超或手术探查,其中腹部强化CT仍为主要确诊手段之一,占80%。根据治疗方式不同分为非手术治疗组(n=42),开腹手术组(n=32)和介入溶栓组(n=14)。与非手术治疗组相比,开腹手术组住院时间及术后肺部感染率偏高(P0.05,差异有统计学意义。对于手术组,早期(T24h接受手术治疗与晚期(T≥24h)接受手术治疗患者相比,晚期患者较早期接受手术治疗肠切除距离偏长,短肠综合征发生率偏高(P0.05差异有统计学意义。介入治疗组与非手术治疗组相比,住院时间及生存率无明显统计学差异,可作为早期临床治疗方法之一。根据Logistic回归模型分析,其中6个因素进入回归方程,按其作用强弱分为:持续性腹痛、呼吸频率、肠壁水肿、术前白细胞水平、便血、术前脉率。Logistic预测模型对SMVT所致小肠坏死预测准确度为85.23%,灵敏度为71.88%,特异度为92.86%,其中kappa值为0.67,证实该预测结果与实际结果有较高的一致性。结论:SMVT发病情况总体呈现出逐年上升趋势。肠系膜上静脉血栓仍主要以腹痛就诊。腹部强化CT可作为该病确诊首选。血管内介入溶栓可作为早期有效治疗方法之一。持续性腹痛、呼吸频率、肠壁水肿、术前白细胞水平、便血、术前脉率可作为早期临床判断肠坏依据,肠坏死征像一但确立,早期剖腹探查可明显降低肠切除距离。
[Abstract]:Objective: to investigate the clinical features, diagnosis and treatment of superior mesenteric venous thrombosis (SMV). Methods: the clinical data of 88 cases of SMVT diagnosed in our hospital from January 2006 to December 2016 were analyzed retrospectively. According to whether there were intestinal infarction, 32 cases of intestinal necrosis caused by SMVT were selected as the study group, and 56 cases of SMVT were used as control group. The clinical manifestation, laboratory examination, imaging examination and other comprehensive indexes were statistically analyzed, and multivariate Logistic regression analysis was performed to determine the relationship between intestinal necrosis induced by SMVT and clinical risk factors, and to establish a Logistic predictive model. Results the accuracy, sensitivity and specificity of predicting intestinal necrosis caused by SMVT were evaluated in 88 patients with SMVT. Results there were 62 males and 26 females aged 53.4 卤12.4 years. The mortality rate was 3.5. Among them, 35 patients had abdominal operation history, 31 patients had hepatitis, 31 patients had cirrhosis, 4 patients had history of malignant tumor, 4 patients had history of cardiovascular and cerebrovascular diseases, 3 patients had history of diabetes, and 1 patient had systemic lupus erythematosus. In the other 11 patients, no significant high risk factors were found. Abdominal pain was the main clinical manifestation, accounting for 99%, of which the persistence and limitation accounted for 3366%, followed by abdominal distension, vomiting, fever and bloody stool, etc. Each of them accounted for 64% and 42%, and 28%. All the patients underwent enhanced abdominal CTDSA, B-ultrasound or surgical exploration. Among them, enhanced abdominal CT was still one of the main means of diagnosis. The patients were divided into two groups: the non-operative treatment group (n = 42), the open operation group (n = 32) and the interventional thrombolytic group (n = 14). Compared with the non-operative group, the length of hospitalization and the postoperative lung infection rate in the open operation group were significantly higher than those in the non-operative group (P 0.05). Compared with the patients with advanced stage T 鈮，

本文编号：1524365