本文選題：妊娠 + 腸系膜��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:探討妊娠早期合并腸系膜靜脈血栓形成的臨床特征及診治現(xiàn)狀。方法:對2016年慈溪市第三人民醫(yī)院收治的1例妊娠早期合并腸系膜靜脈血栓形成患者病例進(jìn)行報道,并復(fù)習(xí)國內(nèi)外1996～2016年相關(guān)文獻(xiàn),共收集到4個病例對疾病進(jìn)行回顧性分析。結(jié)果:發(fā)病孕周跨度為6～12周。4例均以腹痛為首發(fā)癥狀,伴有不同程度惡心、嘔吐等癥狀,其中2例誤診為流產(chǎn)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�；颊呔�(jīng)多普勒超聲、CT或手術(shù)診斷,1例通過低分子肝素抗凝保守治療治愈,3例行壞死腸管切除術(shù)及腸吻合術(shù)。母體預(yù)后均良好,1例術(shù)后繼續(xù)妊娠至足月分娩,1例發(fā)生于藥物流產(chǎn)后,2例在血栓穩(wěn)定后選擇人工流產(chǎn)終止。結(jié)論:妊娠早期合并腸系膜血栓形成極為罕見,易栓癥是其主要病因。臨床變現(xiàn)無特異性,主要表現(xiàn)為腹痛,診斷需要根據(jù)臨床表現(xiàn)及輔助檢查進(jìn)行綜合判斷,CT最具診斷價值。對于妊娠早期出現(xiàn)腹痛且有易栓癥高危因素的患者,應(yīng)盡早鑒別排除。對疑似病例,盡早使用以低分子肝素抗凝為主的綜合治療,對于治療期間出現(xiàn)嚴(yán)重腹膜炎體征患者,及時手術(shù)探查并切除壞死腸管是保障母嬰安全的關(guān)鍵。
[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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.255
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本文編號：1791324