本文選題：腸系膜靜脈血栓形成 + 致病因素　； 參考：《浙江大學》2015年碩士論文

【摘要】：目的：探討腸系膜靜脈血栓形成的病因、臨床表現(xiàn)、早期診斷及治療。 方法：回顧性分析2006年1月至2015年1月浙江大學醫(yī)學院附屬第二醫(yī)院收治的39例腸系膜靜脈血栓形成病例資料。 結(jié)果：共收集腸系膜靜脈血栓形成39例,其中男性27例,女性12例,平均年齡54.8±14.3歲。其中20例患者有腹部手術(shù)史(13例為脾臟切除術(shù)),14例伴有肝硬化,6例有腹腔局部炎癥因素,6例有深靜脈血栓病史,2例伴腹部外傷史,淋巴瘤化療后、系統(tǒng)性紅斑狼瘡、布加綜合征各1例。3例患者未發(fā)現(xiàn)明顯致病因素。腹痛為最常見癥狀,占82.1%,其次為惡心嘔吐、嘔血黑便及腹脹,分別占35.9%、28.2%和23.1%,偶然發(fā)現(xiàn)占2.6%。根據(jù)病程及臨床表現(xiàn),74.4%患者為急性/亞急性病程,25.6%為慢性病程。所有患者均經(jīng)CT、CTA、MRA、多普勒彩超或手術(shù)診斷,其中30.8%為單發(fā)性腸系膜靜脈血栓形成,53.8%為門靜脈及腸系膜靜脈血栓形成,15.4%為門靜脈、腸系膜靜脈、脾靜脈廣泛血栓形成。入院后,31例行抗凝治療,以低分子肝素、華法林為主,10例同時予全身尿激酶溶栓治療。9例行手術(shù)治療,其中7例術(shù)中發(fā)現(xiàn)腸梗死,行梗死腸段切除,2例為肝硬化伴食管胃底靜脈曲張破裂出血保守無效,行脾切除+賁門周圍血管離斷術(shù)。共記錄4例死亡,其中3例為腸切除術(shù)后,總體死亡率及術(shù)后死亡率分別為10.3%和33.3%。 結(jié)論：腸系膜靜脈血栓形成多以腹痛就診,無特異性臨床表現(xiàn),臨床上診斷主要依靠增強CT等影像學檢查。治療上以抗凝治療為主,但肝硬化伴腸系膜靜脈血栓形成患者的抗凝治療尚無一致意見。對發(fā)生腸梗死、腸穿孔的患者需手術(shù)切除壞死腸段,但術(shù)后死亡率較高。提高對腸系膜靜脈血栓形成的警惕性,早期發(fā)現(xiàn)并診斷,盡早開始抗凝治療,防止腸梗死的發(fā)生,是改善患者預后的關(guān)鍵。
[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 鹵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.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R657.2

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相關(guān)期刊論文 前2條

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本文編號：1739669