1'112巴堕鏖迟堡堡迨垫!垒笙!旦篁望鲞箜!塑业里i型坠丛i型坐鱼堕堡尘塑!!!些兰!!塑!:!!丛篓塾垫!兰肠系膜上静脉血栓形成:切勿贻误诊治时机吴梦涛,张勇学,陆清声,景在平·29·[摘要】目的探讨肠系膜上静脉血栓形成(superiormesentericvenousthrombosis,SMVT)的早期诊断方法及最佳诊治时机和策略。方法回顾分析我院2010年3月--2013年lO月收治的42例SMVT的临床资料,按病程分为急性组19例和慢性组23例,分析两组临床表现、诊治经过及治疗效果。结果42例均以腹痛为主要表现,急性组表现为上腹部、脐周及全腹部绞痛或胀痛,慢性组表现为腹部及脐周胀痛,且急性组血白细胞、体温显著高于慢性组(P均<0.001)。两组均经计算机断层x线血管造影(CTA)检查确诊,根据病情分别行小肠切除术、经肠系膜上动脉置管溶栓术及药物抗凝治疗等,急性组治疗有效率为94.8%,病死率为5.2%,慢性组治疗有效率为95.7%,病死率为4.3%。结论CTA是确诊SMVT的首选手段,并能明确剖腹探查术的适应证。通过有效措施促进侧支循环建立,防止远期血栓复发及门静脉高压相关并发症,是SMVT的主要治疗策略。[关键词】肠系膜静脉血栓形成;cT血管造影;置管溶栓;肠系膜上动脉置管溶栓术[中国图书资料分类号]R572.3[文献标志码]A[文章编号]1002—3429(2014)03-0029-04『Doll10.3969/j.issn.1002.3429.2014.03.010optimalDiagnoMsandTreatmentTimeforMesentericVenousThrombosisWUMeng—tao,ZHANGYong—xue,LUQing-sheng,JINGZai·ping(DepartmentofVascularSurgeryPLAInstituteofVaseu—larSurgery,ChanghaiHospitalAffiliatedtoSecondMilitaryMedicalUniversity,Shanghai200433,China)[Abstract]ObjectiveToinvestigatetheearlydiagnosis,optimaltreatmenttimeandstrategyofsuperiormesentericvenousthrombosis(SMVT).MethodsClinicaldataof42patientswithSMVTinourhospitalduringMarch2010andOcto—ber2013wasretrospectivelyanalyzed.Thesepatientsweredividedintoacutegroup(n=19)andchronicgroup(n=23)bythecourseofdisease.Clinicalmanifestations,diagnosisandtherapeuticeffectinthetwogroupswereanalyzed.ResultsAllthe42patientssufferedabdominalpains.Patientsintheacutegroupsufferedcrampsordistendingpainsinepigastrium,peri—umbilicalorwholeabdomen,whilepatientsinchronicgroupsuffereddistendingpainsinperiumbilicalorwholeabdomen.Thecountsofwhitebloodcellsandbodytemperatureintheacutegroupweresignificantlyhigherthanthoseinthechronicgroup(averageP<0.001).SMVTwasdiagnosedafterCTangiography.Enteralresection,intrasuperiormesenteriearterialcathe—ter—directedthrombolysisandanticoagulanttherapywereperformedaccordingtodifferentconditions.Theeffectiverateandfa—talityratewere94.8%and5.2%intheacutegroup.and95.7%and4.3%inthechronicgrouprespectively.ConclusionCTangiographyisthepreferreddiagnosticmethodforSMVT,anditcanhelpdefinetheindicationsoflaparotomy.ThemaintherapiemethodsforSMVTarepromotingtheestablishmentofcollateralcirculationwitheffectivemeasures,andpreventingfu—turerecurrenceofthrombosisandportalhypertension—relatedcomplications.[Keywords]Mesentericvenousthrombosis;CTangiography;Catheter-directedthrombolysis;Intrasuperiormesenter—icarterialcatheter—directedthrombolysis肠系膜上静脉血栓形成(superiormesentericvenousthrombosis,SMVT)是临床少见疾病,约占急性肠缺血疾病的5%~15%⋯,因腹部体征不典型,常不能准确判断肠管血循环和功能变化情况,临床误诊率高,极易贻误病情。本文回顾性分析我院2010年3月一2013年10月收治的42例SMVT的临床资料,以探讨SMVT的早期诊断方法及最佳诊治时机和策略。基金项目:国家自然科学基金项目(81170291)作者单位:200433上海,第二军医大学附属长海医院血管外科全军血管外科研究所通讯作者:陆清声,E-mail:lu...