CAJ | 학술논문

目的探讨急性肠系膜上静脉血栓形成的治疗方法.方法 2006年10月至2012年2月共收治31例急性肠系膜上静脉血栓形成的患者,分别做了坏死小肠切除及肠系膜上静脉切开取栓或经肠系膜上动脉置管间接肠系膜上静脉溶栓治疗,分析2种治疗方式的疗效及适应证.结果外科手术治疗9例,其中6例术后痊愈,3例因消化道出血无法抗凝、溶栓,术后仍有腹胀,造影可见肠系膜上静脉内血栓残留;介入治疗22例中有17例术后72h内症状明显改善,其余症状改善时间为术后5～7d.2例置管溶栓过程中并发少量消化道出血,终止溶栓治疗;1例置管溶栓48 h后腹痛症状加重,中转开腹手术.本组随访25例(81％),随访时间5 ～35个月,平均(19±5)个月.20例无腹胀、腹痛,3例有饱食后腹部胀满感.结论合理选择急性肠系膜上静脉血栓治疗适应证是取得良好疗效的关键,肠系膜上动脉置管间接肠系膜上静脉溶栓是一种操作简单、风险较小、疗效确切的方法.
목적 탐토급성장계막상정맥혈전형성적치료방법.방법 2006년10월지2012년2월공수치31례급성장계막상정맥혈전형성적환자,분별주료배사소장절제급장계막상정맥절개취전혹경장계막상동맥치관간접장계막상정맥용전치료,분석2충치료방식적료효급괄응증.결과 외과수술치료9례,기중6례술후전유,3례인소화도출혈무법항응、용전,술후잉유복창,조영가견장계막상정맥내혈전잔류;개입치료22례중유17례술후72h내증상명현개선,기여증상개선시간위술후5～7d.2례치관용전과정중병발소량소화도출혈,종지용전치료;1례치관용전48 h후복통증상가중,중전개복수술.본조수방25례(81％),수방시간5 ～35개월,평균(19±5)개월.20례무복창、복통,3례유포식후복부창만감.결론 합리선택급성장계막상정맥혈전치료괄응증시취득량호료효적관건,장계막상동맥치관간접장계막상정맥용전시일충조작간단、풍험교소、료효학절적방법.
Objective To evaluate the surgical and interventional therapy in patients with acute superior mesenteric vein thrombosis.Methods In this series,31 acute superior mesenteric vein thrombosis(SMVT) cases were reviewed from Oct 2006 to Feb 2012.According to varied clinical presence,patients received superior mesenteric vein thrombectomy with necrotic bowel resection or indirected catheter thrombolysis through superior mesenteric artery.Results 6 of 9 cases undergoing surgery were cured and other 3 still complained abdominal distension when discharged for not being able to bear anticoagulation and thrombolysis after operation due to alimentary tract hemorrhage,and residual thrombus was shown in superior veins by venography.17 of 22 treated by interventional therapy gained obvious relief within 72 hours after intervention,others gained symptomatic relief in 5-7 days.Indirected catheter thrombolysis were interrupted in 2 due to alimentary tract hemorrhage.One patient was shifted to surgery 48 hours after catheter thrombolysis due to deterioration.Mean duration of follow-up after hospital discharge was (19 ± 5) months in 25 cases,20 had no abdominal distension and pain,3 with postcibal abdominal distension.Conclusions Indirected thrombolytic therapy by way of the superior mesenteric artery is a technically simple,safe and effective therapy for patients with acute SMVT.