急性肠系膜上静脉血栓形成阶梯式治疗模式68例临床分析

摘要

Objective To investigate the effect of Gradient treatment for acute superior mesenteric venous thrombosis ( ASMVT)� Methods Clinic data of 68 patients of ASMVT admitted in Department of General Surgery, Jinling Hospital, Medical School of Nanjing University from January 2009 to December 2014 were analyzed retrospectively� There were 50 male and 18 female patients with a mean age of (45±12) years� These patients were conducted by the stepwise treatment model ( endovascular treatment⁃damage control surgery⁃surgical intensive care⁃intestinal rehabilitation treatment ) � Clinical outcomes and complications were compared during the follow⁃up period� Differences about bowel resection length of endovascular treatment and surgical procedures were evaluated with t test� Results In the 68 cases, 24 cases were cured simply by endovascular treatment, 19 cases received surgical procedures alone ( group surgery)� Twenty⁃five patients received endovascular treatment combined with surgical procedures ( group combined), including 6 cases temporary abdominal closure� The overall mortality rate was 2�9% (2/68) during hospitalization� The range of bowel resection of group combined significantly reduced compared with group surgery ((92±14) cm vs� (162±27) cm, t=-2�377, P=0�022)� During 1⁃year follow⁃up period, 4 cases suffered from short bowel syndrome, whom underwent surgery alone. Conclusions Early diagnosis and treatment is the key to treatment of ASMVT, the rapid improvement of intestinal ischemia is particularly important for prognosis� Combination therapy significantly save more residual small intestine and avoid short bowel syndrome� The selection of early gradient treatment can significantly reduce the mortality and improve the prognosis of ASMVT patients.%目的：探讨急性肠系膜上静脉血栓（ ASMVT）阶梯式治疗的效果。方法回顾性分析2009年1月至2014年12月南京军区南京总医院普通外科收治的ASMVT患者68例，男性50例，女性18例，年龄（45±12）岁。总结ASMVT发病因素和临床特征，采用腔内介入⁃损伤控制手术⁃重症监护⁃肠康复治疗的阶梯化治疗模式，分析血管通畅率、小肠切除长度、手术并发症和远期疗效。采用t检验比较不同治疗方式患者的疗效指标。结果在阶梯式治疗模式的指导下，68例患者单纯腔内治疗24例，手术治疗19例，腔内联合手术治疗25例，其中暂时性腹腔开放患者6例。住院期间死亡2例，总治愈率为97�1％。与单纯手术治疗组相比，腔内联合手术组小肠切除范围明显减少[（92±14）cm比（162±27）cm，t＝－2�377，P＝0�022]。所有患者随访1年，随访期间4例患者发生短肠综合征，均为接受单纯手术治疗的患者。结论早期诊断、早期治疗是治疗ASMVT的关键，快速改善肠缺血状态对于提高患者预后尤为重要。阶梯式治疗模式能明显减少小肠的切除范围，避免短肠综合征的发生，有利于患者的远期预后。