39例肠系膜静脉血栓形成的诊治分析

发布时间：2018-04-12 12:04

本文选题：肠系膜静脉血栓形成 + 致病因素　；参考：《浙江大学》2015年硕士论文

【摘要】：目的：探讨肠系膜静脉血栓形成的病因、临床表现、早期诊断及治疗。方法：回顾性分析2006年1月至2015年1月浙江大学医学院附属第二医院收治的39例肠系膜静脉血栓形成病例资料。结果：共收集肠系膜静脉血栓形成39例,其中男性27例,女性12例,平均年龄54.8±14.3岁。其中20例患者有腹部手术史(13例为脾脏切除术),14例伴有肝硬化,6例有腹腔局部炎症因素,6例有深静脉血栓病史,2例伴腹部外伤史,淋巴瘤化疗后、系统性红斑狼疮、布加综合征各1例。3例患者未发现明显致病因素。腹痛为最常见症状,占82.1%,其次为恶心呕吐、呕血黑便及腹胀,分别占35.9%、28.2%和23.1%,偶然发现占2.6%。根据病程及临床表现,74.4%患者为急性/亚急性病程,25.6%为慢性病程。所有患者均经CT、CTA、MRA、多普勒彩超或手术诊断,其中30.8%为单发性肠系膜静脉血栓形成,53.8%为门静脉及肠系膜静脉血栓形成,15.4%为门静脉、肠系膜静脉、脾静脉广泛血栓形成。入院后,31例行抗凝治疗,以低分子肝素、华法林为主,10例同时予全身尿激酶溶栓治疗。9例行手术治疗,其中7例术中发现肠梗死,行梗死肠段切除,2例为肝硬化伴食管胃底静脉曲张破裂出血保守无效,行脾切除+贲门周围血管离断术。共记录4例死亡,其中3例为肠切除术后,总体死亡率及术后死亡率分别为10.3%和33.3%。结论：肠系膜静脉血栓形成多以腹痛就诊,无特异性临床表现,临床上诊断主要依靠增强CT等影像学检查。治疗上以抗凝治疗为主,但肝硬化伴肠系膜静脉血栓形成患者的抗凝治疗尚无一致意见。对发生肠梗死、肠穿孔的患者需手术切除坏死肠段,但术后死亡率较高。提高对肠系膜静脉血栓形成的警惕性,早期发现并诊断,尽早开始抗凝治疗,防止肠梗死的发生,是改善患者预后的关键。
[Abstract]:Objective: to investigate the etiology, clinical manifestation, early diagnosis and treatment of mesenteric venous thrombosis.Methods: the data of 39 cases of mesenteric venous thrombosis treated in the second affiliated Hospital of Zhejiang University Medical College from January 2006 to January 2015 were retrospectively analyzed.Results: a total of 39 cases of mesenteric venous thrombosis were collected, including 27 males and 12 females, with an average age of 54.8 卤14.3 years.Of the 20 patients with abdominal surgery, 13 were splenectomy, 14 were associated with cirrhosis, 6 had abdominal inflammatory factors, 6 had deep venous thrombosis, 2 had abdominal trauma, and 2 had systemic lupus erythematosus after chemotherapy.No obvious pathogenic factors were found in 3 cases of Budd-Chiari syndrome.Abdominal pain was the most common symptom, accounting for 82.1%, followed by nausea and vomiting, hematemesis, black stool and abdominal distension, accounting for 28.2% and 23.1%, respectively.According to the course of disease and clinical manifestation, 74.4% of the patients were acute / subacute and 25.6% were chronic.All the patients were diagnosed by CTT CTAA MRA. Doppler ultrasound or surgery. Among them, 30.8% were single mesenteric vein thrombosis, 53.8% were portal vein and mesenteric vein thrombosis, 15.4% were portal vein, and the mesenteric vein and splenic vein were extensively thrombosis.After admission, 31 patients were treated with anticoagulant therapy, 10 patients with low molecular weight heparin and warfarin were treated with systemic urokinase thrombolytic therapy.Two patients with cirrhosis of liver and bleeding of esophageal and gastric varices were treated with splenectomy and pericardial devascularization.A total of 4 deaths were recorded, of which 3 were after enterectomy. The overall mortality and postoperative mortality were 10.3% and 33.3b, respectively.Conclusion: mesenteric venous thrombosis is usually seen with abdominal pain and has no specific clinical manifestations. The diagnosis of mesenteric venous thrombosis mainly depends on enhanced CT and other imaging examinations.Anticoagulant therapy is the main treatment, but there is no consensus on anticoagulant therapy in patients with cirrhosis and mesenteric venous thrombosis.For patients with intestinal infarction and perforation, necrotic intestinal segments should be removed, but the mortality is higher.It is the key to improve the prognosis of patients to improve the prognosis of patients with mesenteric venous thrombosis by improving their vigilance, early detection and diagnosis, and starting anticoagulant therapy as early as possible to prevent the occurrence of intestinal infarction.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.2

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